Individual provider Active NPI

Anita Shallal, M.D.

  • Infectious Disease Physician
  • Detroit, MI
National Provider Identifier
1134570823
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
4301505201 Issued in MI
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(800) 653-6568
NPI assigned
Jun 24, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4351037148 MI
Infectious Disease Physician 207RI0200X 4301505201 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

1000 Oakland Drive
Kalamazoo, MI 49008-8024
Phone (269) 337-4400

Other practice location 1

1000 Oakland Drive
Kalamazoo, MI 49008-8024
Phone (269) 337-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210722002390 MI Practitioner - Infectious DiseasePractitioner - Internal Medicine 9830477231 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Macomb Hospital CorporationGroup PAC ID 7911808381, 349 clinicians
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone (586) 263-2300

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 876-2573

Hospital & facility affiliations

  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
  • Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047
  • Henry Ford Health West Bloomfield Hospital Hospital, W Bloomfield, MI, CCN 230302

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301505201MIMDInfectious Disease Physician
4351037148MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Infectious Disease CurrentSince Jul 21, 2021 Accepting new patients
Henry Ford Macomb Hospital Corporation Infectious Disease CurrentSince Mar 20, 2024 Accepting new patients
Henry Ford Pathology Current Accepting new patients
Henry Ford Health System CurrentSince Jul 21, 2021 Accepting new patients
Henry Ford Macomb Hospital Corporation CurrentSince Mar 20, 2024 Accepting new patients
Henry Ford Health System Past Accepting new patients

Locations

15717 15 Mile Rd
Clinton Twp, MI 48035
Phone (586) 285-3800

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

2799 W Grand Blvd
Ste K13
Detroit, MI 48202

1 Ford Pl
Ste 3A
Detroit, MI 48202
Phone (313) 874-2892

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

Interoperability endpoints

  • Direct secure messaging: ashallal572524@direct.hfhs.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1134570823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DRIVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490088024",
            "telephone_number": "269-337-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "800-653-6568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Oakland Drive",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490088024",
            "country_code": "US",
            "telephone_number": "269-337-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHALLAL",
        "first_name": "ANITA",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-24",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4351037148",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MI",
            "license": "4301505201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.