Healthcare Provider Details

I. General information

NPI: 1871741751
Provider Name (Legal Business Name): JIGNESH SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST DEPT OF MEDICINE
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-1000
  • Fax: 816-404-5014
Mailing address:
  • Phone: 816-218-2523
  • Fax: 816-285-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036130005
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2015012835
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2015012835
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: