Shailaja Devi Abbisetty, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Warren, MI
NPI 1083403554 · NPPES record last updated May 1, 2025
Key facts
- NPI
- 1083403554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 11885 E 12 Mile Rd Ste 200B
Warren, MI 48093-3469 - Phone
- (586) 582-6630
- Fax
- (586) 582-6631
- NPI assigned
- May 1, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250528003469 | MI | Order and Referring Only - Internal Medicine |
0042739484 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
11885 E 12 Mile Rd Ste 200B
Warren, MI 48093-3469
Mailing address
11885 E 12 Mile Rd Ste 200B
Warren, MI 48093-3469
Phone (586) 582-6630
Other providers in Warren, MI
- Ab Home Care LLC
- Ab Kha #1 Place Adult Care Home
- Mohammed Abbas
- Sura Abbas
- Imran Abbasi
- Emily Eubanks Abbott
- Riad Abboud
- Mina Abd
- Eiman Abdallah
- Sarah Ann Abdelrahman
All providers in Warren, MI · Student in an Organized Health Care Education/Training Program in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.