Provider Demographics
NPI:1134280126
Name:SHAH, VISHAL MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:MICHAEL
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 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15035 SOUTHWEST FREEWAY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:713-486-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2803207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200637101Medicaid
TX200637105Medicaid
TX200637102Medicaid
TX200637103Medicaid
TX7817872OtherAETNA
TX8A5231OtherBLUE CROSS BLUE SHIELD
TXP00800510OtherRAILROAD MEDICARE
TX200637104Medicaid
TXP01026668OtherRAILROAD MEDICARE
TX182635700OtherUS DEPT. OF LABOR
TX200637102Medicaid
TX200637101Medicaid
TXTXB143786Medicare PIN
TXP00800510OtherRAILROAD MEDICARE
TX200637104Medicaid