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General NPI Number Information
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NPI Number | 1235349929
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Entity Type | Organization
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Legal Business Name | SHAH MEDICAL GROUP APMC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 5607 MIRADOR CIR
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City | SHREVEPORT
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State | LA
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Zip | 71119-4009
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Country | US
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Telephone | 318-671-1745
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3591
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City | SHREVEPORT
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State | LA
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Zip | 71133-3591
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Country | US
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Telephone | 318-671-1745
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MRUNALINI B SHAH
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Credential | MD
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Telephone | 318-671-1745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | L40598R
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License Number State | LA
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