Provider Demographics
NPI:1154322162
Name:SHAH, TEJAS K (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:K
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 1:7777 FOREST LN STE B246
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6816
Mailing Address - Country:US
Mailing Address - Phone:972-566-2043
Mailing Address - Fax:877-563-1827
Practice Address - Street 1:7777 FOREST LN STE B246
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6816
Practice Address - Country:US
Practice Address - Phone:972-566-2043
Practice Address - Fax:877-563-1827
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM89942080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1154322162Medicaid
TNI31110Medicare UPIN
TN3330609Medicare ID - Type Unspecified
WI1154322162Medicaid
WI68086 1152Medicare PIN