Shylaja Gontina-Khatiwala, MD

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

4301076421 Issued in MI

Practice address

9600 N Rushton Rd
South Lyon, MI 48178-8849

Phone

(248) 721-1510

NPI assigned

Jul 21, 2005

Last updated

Sep 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Family & Sports Medical Center

  • Sports Medicine (Family Medicine) Physician
  • Plymouth, MI
  • NPI 1740280676
  NPD (past)
• Michigan Medical Associates, P.C.

  • Primary Care Clinic/Center
  • Plymouth, MI
  • NPI 1780696328
  NPD (past)
• Rushton Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • South Lyon, MI
  • NPI 1780452565
  NPD (past)

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1205836137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9600 N RUSHTON RD",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788849",
            "telephone_number": "248-721-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 N RUSHTON RD",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788849",
            "telephone_number": "248-721-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONTINA-KHATIWALA",
        "first_name": "SHYLAJA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-21",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301076421",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MI",
            "license": "4301076421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TYPE 1 (IND) NPI #",
            "identifier": "1205836137",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11438804",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "4301076421",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDS #",
            "identifier": "5315052867",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IND PIN #",
            "identifier": "P37000001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Lee Gerwatowski, LLPC
• Stephen M Ghezzi, D.D.S.
• Valerie E Gilbert
• Carol R Glenn, M.P.T.
• Sharon Goins, P.T.
• Ryan Fielding Grant, PHARM.D.
• Molly Green, CD-L, CD-PIC
• Lauren H. Groskaufmanis, MD
• Guardian Group Management LLC.
• Emily Therese Gutman, LMSW

• Addiction Medicine (Family Medicine) Physician in South Lyon, MI
• Providers in South Lyon, MI by specialty
• Addiction Medicine (Family Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.