Provider Demographics
NPI:1275514218
Name:SHAH, SYED ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:ASIF
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 1:6709 S MINNESOTA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2593
Mailing Address - Country:US
Mailing Address - Phone:605-271-2277
Mailing Address - Fax:605-275-0066
Practice Address - Street 1:6709 S MINNESOTA AVE STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2593
Practice Address - Country:US
Practice Address - Phone:605-271-2277
Practice Address - Fax:605-275-0066
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35299207R00000X
SD3984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6002940Medicaid
SD6002945Medicaid
SD6002944Medicaid
SDS4132Medicare PIN
SD6002940Medicaid
G13383Medicare UPIN