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General NPI Number Information
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NPI Number | 1033439989
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Entity Type | Individual
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Provider Name | RUSHABH ANILKUMAR SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1919 LAKE AVE SUITE 110
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City | PLYMOUTH
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State | IN
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Zip | 46563-7830
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Country | US
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Telephone | 574-948-5290
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Fax | 574-948-5495
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Provider Business Mailing Address
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Address Line | 707 CEDAR ST STE 405
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City | SOUTH BEND
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State | IN
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Zip | 46617-2059
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301096224
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01072555A
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License Number State | IN
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