Provider Demographics
NPI:1437121340
Name:SHAH, MANISH HARIKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:HARIKANT
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 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 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:303-321-0399
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 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:303-321-0399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2320282086S0122X
CO434792086S0122X
GA462452086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90379781Medicaid
CO30456525Medicaid
CO803225Medicare ID - Type UnspecifiedGROUP
COI-42211Medicare UPIN
CO90379781Medicaid