Provider Demographics
NPI:1255327425
Name:SHAH, SAYED (MD)
Entity Type:Individual
Prefix:
First Name:SAYED
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 1:2206 E 52ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2790
Mailing Address - Country:US
Mailing Address - Phone:563-355-7411
Mailing Address - Fax:563-355-7431
Practice Address - Street 1:2206 E 52ND ST
Practice Address - Street 2:STE A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2790
Practice Address - Country:US
Practice Address - Phone:563-355-7411
Practice Address - Fax:563-355-7431
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35468208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
101982OtherHEALTH ALLIANCE
99622OtherWELLMARK
IA0568998Medicaid
IL421060724A6OtherJOHN DEERE IN RI COUNTY
318499OtherCOVENTRY
IA95185OtherIA BC/BS SEEN IN RI
IL421060724003Medicaid
IL036110953Medicaid
IL95184OtherIA BC/BS SEEN IN MOLINE
ILIL01A6OtherJOHN DEERE EDI# RI COUNTY
ILP00452391OtherRR MEDICARE
IL8122859OtherIL BC/BS
101982OtherHEALTH ALLIANCE
ILK38614Medicare PIN
ILP00452391OtherRR MEDICARE
318499OtherCOVENTRY
IAIB2935Medicare PIN