MEDICARE: SUBHASH H 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	174400000X	Specialist	04-24004	KS
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	04-24004	KS

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	:	1588667372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUBHASH H SHAH MD

Provider Business Mailing Address
First Line	:	220 S HILLSIDE ST STE A
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67211-2151
Country	:	US
Telephone Number	:	316-686-6866
Fax Number	:	316-686-9797

Provider Business Practice Location Address
First Line	:	220 S HILLSIDE ST STE A
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67211-2151
Country	:	US
Telephone Number	:	316-686-6866
Fax Number	:	316-686-9797

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/06/2019

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