MEDICARE: KUSH 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	2085R0204X	Vascular & Interventional Radiology Physician	V6833	TX
2	2085R0204X	Vascular & Interventional Radiology Physician	27275	NV
3	202K00000X	Phlebology Physician	ME145681	FL
4	2085R0204X	Vascular & Interventional Radiology Physician	ME145681	FL

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	:	1710304746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUSH SHAH MD

Provider Business Mailing Address
First Line	:	3820 NORTHDALE BLVD STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1893
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

Provider Business Practice Location Address
First Line	:	11221 KATY FWY STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2105
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:

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

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/11/2026

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Directions to “ KUSH SHAH MD” Practice Location

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