MEDICARE: DR. NISH 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	BP10046758	TX
2	207QS0010X	Sports Medicine (Family Medicine) Physician	Q3437	TX

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	:	1255775177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISH SHAH M.D.

Provider Business Mailing Address
First Line	:	7790 W GRAND PKWY S STE 100
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5830
Country	:	US
Telephone Number	:	281-690-4678
Fax Number	:

Provider Business Practice Location Address
First Line	:	7790 W GRAND PKWY S STE 100
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5830
Country	:	US
Telephone Number	:	281-690-4678
Fax Number	:

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	03/17/2018

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Directions to “ DR. NISH SHAH M.D.” Practice Location

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