Provider Demographics
NPI:1326004896
Name:SHAH, TUSHAR NANDLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:TUSHAR
Middle Name:NANDLAL
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0325
Mailing Address - Fax:
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-247-1120
Practice Address - Fax:970-247-1128
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-43883207RA0001X
KY46040207RC0000X
PAMD463497207RC0000X
OH35-08-7069207RC0000X
CODR.0067374207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2595955Medicaid
P00290133Medicare PIN
OHH12635Medicare UPIN
OH4171473Medicare PIN
OH2595955Medicaid
OH4171471Medicare PIN