Provider Demographics
NPI:1265457485
Name:SHAH, ANIMESH CHANDULAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIMESH
Middle Name:CHANDULAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANIMESHKUMAR
Other - Middle Name:CHANDULAL
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1100
Mailing Address - Fax:952-942-3361
Practice Address - Street 1:65 E INDIA ROW APT 33C
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3323
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:952-942-3361
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC523202085R0202X
FLME946212085R0202X
KS4312462085R0202X
MA2270882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002137501Medicare PIN