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General NPI Number Information
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NPI Number | 1386907707
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Entity Type | Organization
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Legal Business Name | DR. YOGENDRA A. SHAH, MD. SC
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 3165 MYRTLE AVE
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City | GRANITE CITY
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State | IL
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Zip | 62040-5012
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Country | US
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Telephone | 618-451-7717
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Fax | 618-451-7780
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Provider Business Mailing Address
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Address Line | 3165 MYRTLE AVE
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City | GRANITE CITY
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State | IL
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Zip | 62040-5012
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Country | US
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Telephone | 618-451-7717
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Fax | 618-451-7780
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Authorized Official
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Title or Position | GYN
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Name | DR. YOGENDRA AMBALAL SHAH
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Credential | M.D.
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Telephone | 618-451-7717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036048989
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License Number State | IL
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