Healthcare Provider Details

I. General information

NPI: 1396131090
Provider Name (Legal Business Name): TEJAS ELESH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W UNION HILLS DR STE 390
PHOENIX AZ
85027-5197
US

IV. Provider business mailing address

5151 E BROADWAY RD STE 107
MESA AZ
85206-1346
US

V. Phone/Fax

Practice location:
  • Phone: 602-443-4068
  • Fax: 623-434-8310
Mailing address:
  • Phone: 480-290-7000
  • Fax: 602-254-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number66710
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number66710
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number66710
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: