Provider Demographics
NPI:1083060263
Name:SHAH, JAGRUTI NIMIT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGRUTI
Middle Name:NIMIT
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAGRUTI
Other - Middle Name:NARENDRAKUMAR
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2142 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3895
Mailing Address - Country:US
Mailing Address - Phone:419-291-4000
Mailing Address - Fax:419-479-6102
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-291-4000
Practice Address - Fax:419-479-6102
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2023-11-03
Deactivation Date:2017-01-05
Deactivation Code:
Reactivation Date:2017-01-11
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35135666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program