Healthcare Provider Details

I. General information

NPI: 1013332857
Provider Name (Legal Business Name): ANKUR SHAH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 OLENTANGY RIVER RD STE 100
COLUMBUS OH
43214-3467
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-262-6772
  • Fax: 614-533-0162
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number34.012545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: