Provider Demographics
NPI:1043229206
Name:SHAH, KIRAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:H
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 14TH ST N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-8902
Mailing Address - Country:US
Mailing Address - Phone:409-948-3810
Mailing Address - Fax:409-948-0722
Practice Address - Street 1:926 14TH ST N
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-8902
Practice Address - Country:US
Practice Address - Phone:409-948-3810
Practice Address - Fax:409-948-0722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1241207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000B56E3Medicaid
TX00B56EMedicare PIN
TXP000B56E3Medicaid