Provider Demographics
NPI:1265510465
Name:SHAH, YOGESH (MD)
Entity Type:Individual
Prefix:
First Name:YOGESH
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 1:1801 HICKMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4104
Mailing Address - Country:US
Mailing Address - Phone:515-282-5700
Mailing Address - Fax:515-282-5705
Practice Address - Street 1:1801 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1505
Practice Address - Country:US
Practice Address - Phone:515-282-5700
Practice Address - Fax:515-282-5705
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6117812Medicaid
IA1265510465Medicaid
IA8809OtherMIDLANDS CHOICE
IAIA0148OtherJOHN DEERE
IA25613OtherWELLMARK OF IOWA
IA1265510465Medicaid
IA6117812Medicaid
IA415300005Medicare PIN