MEDICARE: DR. SAMIR KAUSHIK SHAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2086S0129X	Vascular Surgery Physician	258805	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013180553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIR KAUSHIK SHAH MD

Provider Business Mailing Address
First Line	:	1329 SW 16TH ST RM 3230
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1128
Country	:	US
Telephone Number	:	352-273-5484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 SW 16TH ST RM 3230
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1128
Country	:	US
Telephone Number	:	352-273-5484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	01/27/2024

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