Healthcare Provider Details

I. General information

NPI: 1275503948
Provider Name (Legal Business Name): AMIT K SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 UNIVERSITY BLVD E SUITE 400
TUSCALOOSA AL
35401-2086
US

IV. Provider business mailing address

701 UNIVERSITY BLVD E SUITE 400
TUSCALOOSA AL
35401-2086
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-0694
  • Fax: 205-752-6244
Mailing address:
  • Phone: 205-752-0694
  • Fax: 205-752-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2611
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME86156
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2611
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number26111
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: