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General NPI Number Information
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NPI Number | 1902868433
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Entity Type | Individual
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Provider Name | RAKESH R SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 333 N 1ST ST STE 250
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City | BOISE
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State | ID
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Zip | 83702-6132
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Country | US
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Telephone | 208-381-9384
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Fax |
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | J2321
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MC-1523
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 5145
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | MD210225
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License Number State | OR
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