MEDICARE: SIDDHARTH RAJNIKANT 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	207Q00000X	Family Medicine Physician	27259	AL

General Provider Information

NPI Number	:	1194770461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDDHARTH RAJNIKANT SHAH M.D.

Provider Business Mailing Address
First Line	:	2038 SPRINGDALE LN
Second Line	:
City	:	TARRANT
State	:	AL
Zip	:	35217-2028
Country	:	US
Telephone Number	:	205-841-7665
Fax Number	:	205-841-8366

Provider Business Practice Location Address
First Line	:	2038 SPRINGDALE LN
Second Line	:
City	:	TARRANT
State	:	AL
Zip	:	35217-2028
Country	:	US
Telephone Number	:	205-841-7665
Fax Number	:	205-841-8366

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	09/01/2021

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