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NPI Code Detail

MEDICARE: GAUTAM MOTLLAL SHAH M.D.

MEDICARE: GAUTAM MOTLLAL SHAH M.D.
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
1207R00000XInternal Medicine Physician10116AZ
2207RP1001XPulmonary Disease Physician10116AZ

Other Identifiers

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

General Provider Information

NPI Number : 1831143676
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAUTAM MOTLLAL SHAH M.D.
Provider Business Mailing Address
First Line : 10192 W. COGGINS DRIVE
Second Line :
City : SUN CITY
State : AZ
Zip : 85351-3405
Country : US
Telephone Number : 623-974-2434
Fax Number : 623-974-4925
Provider Business Practice Location Address
First Line : 10192 W. COGGINS DRIVE
Second Line :
City : SUN CITY
State : AZ
Zip : 85351-3405
Country : US
Telephone Number : 623-974-2434
Fax Number : 623-974-4925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 03/03/2011

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