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General NPI Number Information
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NPI Number | 1619273851
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Entity Type | Organization
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Legal Business Name | STAR INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 02/06/2011
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Last Update Date | 02/06/2011
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Provider Practice Location Address
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Address Line | 568 S CLEVELAND AVE
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City | WESTERVILLE
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State | OH
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Zip | 43081-8959
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Country | US
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Telephone | 614-901-9700
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Fax | 614-901-9710
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Provider Business Mailing Address
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Address Line | 568 S CLEVELAND AVE
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City | WESTERVILLE
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State | OH
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Zip | 43081-8959
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Country | US
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Telephone | 614-901-9700
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Fax | 614-901-9710
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Authorized Official
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Title or Position | OWNER
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Name | BAHADUR SHAH
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Credential | MD
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Telephone | 614-901-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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