Provider Demographics
NPI:1376729194
Name:AITAZAZ A. SHAH M.D PA
Entity Type:Organization
Organization Name:AITAZAZ A. SHAH M.D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AITAZAZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-380-8100
Mailing Address - Street 1:2900 N I-35
Mailing Address - Street 2:SUITE 118
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5141
Mailing Address - Country:US
Mailing Address - Phone:940-380-8100
Mailing Address - Fax:940-380-8112
Practice Address - Street 1:2900 N I-35
Practice Address - Street 2:SUITE 118
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5141
Practice Address - Country:US
Practice Address - Phone:940-380-8100
Practice Address - Fax:940-380-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9471261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1753279Medicaid
TX0001MSOtherBSBS OF TEXAS
TX8F0492OtherMEDICARE
TX0001MSOtherBSBS OF TEXAS
TX1753279Medicaid