MEDICARE: KIRIT C SHAH P C

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	2084N0400X	Neurology Physician	K6924	TX

General Provider Information

NPI Number	:	1134305899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRIT C SHAH P C

Provider Business Mailing Address
First Line	:	1550 W ROSEDALE ST STE 306
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7407
Country	:	US
Telephone Number	:	817-820-0567
Fax Number	:	817-820-0574

Provider Business Practice Location Address
First Line	:	1550 W ROSEDALE ST STE 306
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7407
Country	:	US
Telephone Number	:	817-820-0567
Fax Number	:	817-820-0574

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIRIT C SHAH
Credential	:	M.D.
Telephone Number	:	817-820-0567

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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