MEDICARE: ATULKUMAR THAKORLAL SHAH M.D.

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	207R00000X	Internal Medicine Physician	C167727	CA
2	207RG0100X	Gastroenterology Physician	C167727	CA
3	207RI0008X	Hepatology Physician	J1039	TX
4	207RT0003X	Transplant Hepatology Physician	C167727	CA
5	207RG0100X	Gastroenterology Physician	J1039	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100004129	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8AB810	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8FX464	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1194729152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATULKUMAR THAKORLAL SHAH M.D.

Provider Business Mailing Address
First Line	:	950 E STATE HIGHWAY 114 STE 220
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-5240
Country	:	US
Telephone Number	:	214-424-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N WALDROP DR STE 509
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-4703
Country	:	US
Telephone Number	:	817-394-4300
Fax Number	:	817-394-0200

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/28/2025

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Directions to “ ATULKUMAR THAKORLAL SHAH M.D.” Practice Location

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