MEDICARE: DR. AMI R SHAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	N7347	TX
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	N7347	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N7347	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1053373001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMI R SHAH MD

Provider Business Mailing Address
First Line	:	6124 WEST PARKER ROAD
Second Line	:	MOB III SUITE 234
City	:	PLANO
State	:	TX
Zip	:	75093-8124
Country	:	US
Telephone Number	:	972-981-7500
Fax Number	:	972-981-3600

Provider Business Practice Location Address
First Line	:	6124 WEST PARKER ROAD
Second Line	:	MOB III SUITE 234
City	:	PLANO
State	:	TX
Zip	:	75093-8124
Country	:	US
Telephone Number	:	972-981-7500
Fax Number	:	972-981-3600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	09/20/2010

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Directions to “ DR. AMI R SHAH MD” Practice Location

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