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Dr. Shylaja Gontina-khatiwala, MD
Addiction Medicine (Family Medicine) Physician in South Lyon, Michigan
NPI 1205836137

Shylaja Gontina-khatiwala is an Addiction Medicine (Family Medicine) Physician based in South Lyon, MI and is specialized in Addiction Medicine. Shylaja Gontina-khatiwala practices in South Lyon, MI and has the professional credentials of MD. The NPI Number for Shylaja Gontina-khatiwala is 1205836137 and holds a License No. 4301076421 (Michigan).

The current practice location address for Shylaja Gontina-khatiwala is 9600 N Rushton Rd, South Lyon, MI and can be reached out via phone at 248-721-1510.

Location: 9600 N Rushton Rd, South Lyon, MI, 48178-8849
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1205836137
Provider Name
Shylaja Gontina-khatiwala
Credential
MD
Provider Entity Type
Individual
Gender
Female
Address
9600 N Rushton Rd, South Lyon, MI, 48178-8849
Phone Number
248-721-1510
Fax Number
Provider Enumeration Date
07/21/2005
Last Update Date
10/19/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
11438804 01 MI CAQH
1205836137 01 MI BCBS TYPE 1 (IND) NPI #
5315052867 01 MI CDS #
4301076421 01 MI STATE LICENSE #
P37000001 01 MI MEDICARE IND PIN #
institution
Provider Business Practice Location Address Details
Address
9600 N Rushton Rd
City
South Lyon
State
Michigan
Zip
48178-8849
Phone Number
248-721-1510
Fax Number
person
Provider Business Mailing Address Details
Address
9600 N Rushton Rd
City
South Lyon
State
Michigan
Zip
48178-8849
Phone Number
248-721-1510
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
-
Taxonomy
207Q00000X
License No.
4301076421 (Michigan)
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
Addiction Medicine
Taxonomy
207QA0401X
License No.
4301076421 (Michigan)
Definition
A family medicine physician who specializes in the diagnosis and treatment of addictions.
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