MEDICARE: MITAL 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	208000000X	Pediatrics Physician	R8664	TX

General Provider Information

NPI Number	:	1730409095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITAL SHAH MD

Provider Business Mailing Address
First Line	:	4201 BEE CAVES RD STE C100
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6493
Country	:	US
Telephone Number	:	512-327-1155
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 BEE CAVES RD STE C100
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6493
Country	:	US
Telephone Number	:	512-327-1155
Fax Number	:

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

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	08/26/2022

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