Healthcare Provider Details

I. General information

NPI: 1255327425
Provider Name (Legal Business Name): SAYED SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 E 52ND ST STE A
DAVENPORT IA
52807-2790
US

IV. Provider business mailing address

2206 E 52ND ST STE A
DAVENPORT IA
52807-2790
US

V. Phone/Fax

Practice location:
  • Phone: 563-355-7411
  • Fax: 563-355-7431
Mailing address:
  • Phone: 563-355-7411
  • Fax: 563-355-7431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35468
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35468
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: