MEDICARE: ASHOK CHAMPAKLAL 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	207R00000X	Internal Medicine Physician	ME67131	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26294	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760476766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHOK CHAMPAKLAL SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 1980
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32902-1980
Country	:	US
Telephone Number	:	321-268-2005
Fax Number	:	321-264-2235

Provider Business Practice Location Address
First Line	:	3808 S HOPKINS AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-5753
Country	:	US
Telephone Number	:	321-268-2005
Fax Number	:	321-264-2235

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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