Healthcare Provider Details

I. General information

NPI: 1437121340
Provider Name (Legal Business Name): MANISH HARIKANT SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E 9TH AVE SUITE 490
DENVER CO
80220-3901
US

IV. Provider business mailing address

4545 E 9TH AVE SUITE 490
DENVER CO
80220-3901
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-3791
  • Fax: 303-321-0399
Mailing address:
  • Phone: 303-399-3791
  • Fax: 303-321-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number232028
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number43479
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number46245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: