Provider Demographics
NPI:1407818461
Name:SHAH, MILAN R (MD)
Entity Type:Individual
Prefix:
First Name:MILAN
Middle Name:R
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 1:4850 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0415
Mailing Address - Country:US
Mailing Address - Phone:661-665-0191
Mailing Address - Fax:661-872-3366
Practice Address - Street 1:4850 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0415
Practice Address - Country:US
Practice Address - Phone:661-665-0191
Practice Address - Fax:661-872-3366
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI28629Medicare UPIN
CA00A876630Medicare ID - Type UnspecifiedACTIVE