Healthcare Provider Details

I. General information

NPI: 1881893741
Provider Name (Legal Business Name): SAMIR RAMESHCHANDRA SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 NW 151ST ST STE 105
MIAMI LAKES FL
33014-2473
US

IV. Provider business mailing address

9500 S DADELAND BLVD STE 200
MIAMI FL
33156-2866
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-3080
  • Fax: 305-596-3073
Mailing address:
  • Phone: 305-468-4185
  • Fax: 305-596-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number38018
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number38018
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME140999
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME140999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: