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NPI Code Detail

MEDICARE: DR. KIRTI K SHAH MD

MEDICARE: DR. KIRTI K 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
1207RN0300XNephrology Physician027248GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3390002084OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700881612
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIRTI K SHAH MD
Provider Business Mailing Address
First Line : 605 OLD NORCROSS RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-4315
Country : US
Telephone Number : 770-962-1231
Fax Number : 770-513-2107
Provider Business Practice Location Address
First Line : 605 OLD NORCROSS RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-4315
Country : US
Telephone Number : 770-962-1231
Fax Number : 770-513-2107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 10/25/2007

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