MEDICARE: DR. LATA 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	41496	TN
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	41496	TN
3	207RP1001X	Pulmonary Disease Physician	41496	TN

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

General Provider Information

NPI Number	:	1275547234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATA SHAH MD

Provider Business Mailing Address
First Line	:	LUNG AND SLEEP CLINIC (D/B/A)
Second Line	:	1112 EAST MAIN STREET
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-2808
Country	:	US
Telephone Number	:	423-293-3711
Fax Number	:	423-293-3900

Provider Business Practice Location Address
First Line	:	LUNG AND SLEEP CLINIC
Second Line	:	1112 EAST MAIN STREET
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-2808
Country	:	US
Telephone Number	:	423-293-3711
Fax Number	:	423-293-3900

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/14/2023

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Directions to “ DR. LATA SHAH MD” Practice Location

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