MEDICARE: RAHUL KAMLESH SHAH M.B.B.S

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	2084A2900X	Neurocritical Care Physician	333346	LA
2	207R00000X	Internal Medicine Physician	BP10044550	TX
3	2084V0102X	Vascular Neurology Physician	333346	LA
4	2084N0400X	Neurology Physician	333346	LA

General Provider Information

NPI Number	:	1073860938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHUL KAMLESH SHAH M.B.B.S

Provider Business Mailing Address
First Line	:	1541 KINGS HWY
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 KINGS HWY
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:	318-626-0000
Fax Number	:

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

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	12/09/2025

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