Healthcare Provider Details

I. General information

NPI: 1770555682
Provider Name (Legal Business Name): BHADRESH B SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 SWEETWATER BLVD SUITE 150
SUGAR LAND TX
77479-3162
US

IV. Provider business mailing address

4780 SWEETWATER BLVD SUITE 150
SUGAR LAND TX
77479-3162
US

V. Phone/Fax

Practice location:
  • Phone: 281-242-2444
  • Fax: 281-242-2448
Mailing address:
  • Phone: 281-242-2444
  • Fax: 281-242-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberK1924
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberK1924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: