Active NPI
Shirin Koudsi
- Physician Assistant
- Bloomfield Hills, MI
National Provider Identifier
1891467155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601010857
- Practice address
- 2337 Heronwood Dr
Bloomfield Hills, MI 48302-0835 - Phone
- (850) 450-9788
- NPI assigned
- Oct 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601010857 | MI | Primary |
Addresses
Primary practice location
2337 Heronwood Dr
Bloomfield Hills, MI 48302-0835
Mailing address
2337 Heronwood Dr
Bloomfield Hills, MI 48302-0835
Phone (850) 450-9788
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601010857 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633305600000",
"number": "1891467155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2337 HERONWOOD DR",
"city": "BLOOMFIELD HILLS",
"state": "MI",
"postal_code": "483020835",
"telephone_number": "850-450-9788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2337 HERONWOOD DR",
"city": "BLOOMFIELD HILLS",
"state": "MI",
"postal_code": "483020835",
"telephone_number": "850-450-9788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOUDSI",
"first_name": "SHIRIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-04",
"last_updated": "2021-10-04",
"certification_date": "2021-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601010857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield Hills, MI
- Jordan Anne Kondrat, PT, DPT
- Patricia A Kondratenko, D.O.
- Marie Eileen Kopmeyer, M.P.T
- Erin Nicole Koppelman, N.P.
- Zenon Paul Kossak, DDS, MD
- Michael Kozlowski, D.C.
- Susan Krawczyk, M.A., CCC-SLP
- Antoinette Marie Kreager, ANP-BC
- Jennifer Lynn Krishnan, M.S. PA-C
- Shankar Lakshminarayanan Krishnan, PT, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.