1639274392 NPI number — MIKE SHAH MD PA

Table of content: (NPI 1639274392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639274392 NPI number — MIKE SHAH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIKE SHAH MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639274392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 941010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75094-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-499-4266
Provider Business Mailing Address Fax Number:
972-591-4605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6957 W PLANO PKWY
Provider Second Line Business Practice Location Address:
SUITE 2600
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-499-4266
Provider Business Practice Location Address Fax Number:
972-591-4605
Provider Enumeration Date:
09/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
MRUGESHKUMAR
Authorized Official Middle Name:
KANAIYALAL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-499-4266

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  L6174 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)