Healthcare Provider Details

I. General information

NPI: 1306161237
Provider Name (Legal Business Name): RICKI UPENDRA SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2010
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 QUIVIRA RD
LENEXA KS
66215-3902
US

IV. Provider business mailing address

9040 QUIVIRA RD
LENEXA KS
66215-3902
US

V. Phone/Fax

Practice location:
  • Phone: 913-944-4900
  • Fax:
Mailing address:
  • Phone: 913-944-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125059316
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036135089
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-42621
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-40860
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: