MEDICARE: DR. DIPAN SHAH M.D.

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	207RC0000X	Cardiovascular Disease Physician	35856	TN
2	207RC0000X	Cardiovascular Disease Physician	M8990	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01309355	OTHER	TX	RR MEDICARE
5	P00639774	OTHER	TX	RAILROAD MEDICARE
8	P01037137	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	8AH673	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1114966470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIPAN SHAH M.D.

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 1901
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-1100
Fax Number	:	713-790-2643

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 1901
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-1100
Fax Number	:	713-790-2643

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	09/02/2014

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Directions to “ DR. DIPAN SHAH M.D.” Practice Location

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