1639113012 NPI number — MRUGESHKUMAR KANAIYALAL SHAH MD

Table of content: MRUGESHKUMAR KANAIYALAL SHAH MD (NPI 1639113012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639113012 NPI number — MRUGESHKUMAR KANAIYALAL SHAH MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAH
Provider Other First Name:
MIKE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639113012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3420 FORESTBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-278-7772
Provider Business Mailing Address Fax Number:
469-429-1052

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:
06/15/2006

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: 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)





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