Provider Demographics
NPI:1407815889
Name:MANISH H SHAH MD PC
Entity Type:Organization
Organization Name:MANISH H SHAH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-399-3791
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:STE 490
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-399-3791
Mailing Address - Fax:
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:STE 490
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-399-3791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30456525Medicaid
CO803224Medicare ID - Type Unspecified
COI42211Medicare UPIN