1497312573 NPI number — DR. PARTH SHAH M.D.

Table of content: DR. PARTH SHAH M.D. (NPI 1497312573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497312573 NPI number — DR. PARTH SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
PARTH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1497312573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/13/2020
NPI Reactivation Date:
02/13/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WESTERN RESERVE HEALTH EDUCATION
Provider Second Line Business Mailing Address:
500 GYPSY LANE, MEDICAL OFFICE BUILDING A
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 W 13 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48073-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-898-4126
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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