Healthcare Provider Details

I. General information

NPI: 1851372585
Provider Name (Legal Business Name): ASHISH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 W THUNDERBIRD BLVD M434
SUN CITY AZ
85351-3004
US

IV. Provider business mailing address

PO BOX 53568
PHOENIX AZ
85072-3568
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-5622
  • Fax: 623-815-2931
Mailing address:
  • Phone: 623-544-5075
  • Fax: 623-544-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25506
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: