Healthcare Provider Details

I. General information

NPI: 1114023652
Provider Name (Legal Business Name): YOGESH G SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18099 LORAIN AVE SUITE 345
CLEVELAND OH
44111-5610
US

IV. Provider business mailing address

18099 LORAIN AVE SUITE 345
CLEVELAND OH
44111-5610
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-7828
  • Fax: 216-476-4069
Mailing address:
  • Phone: 216-476-7828
  • Fax: 216-476-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35058005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: