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General NPI Number Information
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NPI Number | 1710305131
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Entity Type | Individual
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Provider Name | KAISER SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 3333 EVERGREEN DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9493
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Country | US
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Telephone | 616-284-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 WHITE PINE LN
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-5018
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Country | US
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Telephone | 630-802-8747
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301510705
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036147091
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License Number State | IL
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