MEDICARE: DR. MUKHTAR H. 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	2084P0800X	Psychiatry Physician	04-17352	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	260029156	OTHER	KS	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	047770	OTHER	KS	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396763827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUKHTAR H. SHAH M.D.

Provider Business Mailing Address
First Line	:	1148 S HILLSIDE ST
Second Line	:	SUITE 104
City	:	WICHITA
State	:	KS
Zip	:	67211-4006
Country	:	US
Telephone Number	:	316-687-0006
Fax Number	:	316-687-0328

Provider Business Practice Location Address
First Line	:	1148 S. HILLSIDE ST
Second Line	:	SUITE 104
City	:	WICHITA
State	:	KS
Zip	:	67211-4006
Country	:	US
Telephone Number	:	316-687-0006
Fax Number	:	316-687-0328

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/27/2017

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