Healthcare Provider Details

I. General information

NPI: 1174215230
Provider Name (Legal Business Name): MR. DHRUVIL KIRANBHAI SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 EAST MARKET STREET, WESTERN RESERVE HEALTH EDUCATION, INC. 7TH FLOOR
WARREN OH
44483
US

IV. Provider business mailing address

1350 EAST MARKET STREET, WESTERN RESERVE HEALTH EDUCATION, INC. 7TH FLOOR
WARREN OH
44483
US

V. Phone/Fax

Practice location:
  • Phone: 330-675-5706
  • Fax: 330-675-5720
Mailing address:
  • Phone: 330-675-5706
  • Fax: 330-675-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: