MEDICARE: RAJIV 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	52-94765-1205	UT
2	208VP0014X	Interventional Pain Medicine Physician	52-94765-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00050624	OTHER	UT	RAILROAD NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285664185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJIV SHAH M.D

Provider Business Mailing Address
First Line	:	6750 S HIGHLAND DRIVE
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-1829
Country	:	US
Telephone Number	:	801-685-7246
Fax Number	:	801-747-5487

Provider Business Practice Location Address
First Line	:	6750 S HIGHLAND DRIVE
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-1829
Country	:	US
Telephone Number	:	801-685-7246
Fax Number	:	801-747-5487

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/12/2016

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