Healthcare Provider Details

I. General information

NPI: 1649390543
Provider Name (Legal Business Name): MALAY BIPIN SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST SUITE C447
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

740 S LIMESTONE SUITE K 301
LEXINGTON KY
40536-0284
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-4661
  • Fax:
Mailing address:
  • Phone: 859-323-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number44714
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: