Provider Demographics
NPI:1073689634
Name:SHAH, CHANDRAKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRAKANT
Middle Name:
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 1:13033 SW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4601
Mailing Address - Country:US
Mailing Address - Phone:305-382-4901
Mailing Address - Fax:305-487-7280
Practice Address - Street 1:13033 SW 112TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4601
Practice Address - Country:US
Practice Address - Phone:305-382-4901
Practice Address - Fax:305-487-7280
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058773700Medicaid
FL058773700Medicaid
FL14792Medicare ID - Type Unspecified