MEDICARE: MUKESH R 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	207RC0000X	Cardiovascular Disease Physician	35051228S	OH

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	:	1740275627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKESH R SHAH MD

Provider Business Mailing Address
First Line	:	5969 E BROAD ST
Second Line	:	STE 202
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1546
Country	:	US
Telephone Number	:	614-367-0585
Fax Number	:	614-367-0599

Provider Business Practice Location Address
First Line	:	5969 E BROAD ST
Second Line	:	STE 202
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1546
Country	:	US
Telephone Number	:	614-367-0585
Fax Number	:	614-367-0599

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	11/17/2016

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