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1255521332

NPI Code Detail

MEDICARE: REHAN SHAH MD

MEDICARE: REHAN 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	207R00000X	Internal Medicine Physician	071567	GA
2	207RN0300X	Nephrology Physician	MD61072096	WA
3	207RN0300X	Nephrology Physician	071567	GA
4	207RN0300X	Nephrology Physician	S2503	TX
5	390200000X	Student in an Organized Health Care Education/Training Program
6	207RN0300X	Nephrology Physician	ME127447	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255521332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REHAN SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 516
Second Line	:
City	:	OREGON
State	:	IL
Zip	:	61061-0516
Country	:	US
Telephone Number	:	214-272-2774
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 SOUTHPOINT PKWY STE 203
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6286
Country	:	US
Telephone Number	:	904-330-1024
Fax Number	:

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	04/22/2024

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Directions to “ REHAN SHAH MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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