Provider Demographics
NPI:1508830431
Name:SHAH, REKHA (MD)
Entity Type:Individual
Prefix:DR
First Name:REKHA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 E KNOX RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3330
Mailing Address - Country:US
Mailing Address - Phone:602-692-5150
Mailing Address - Fax:480-345-7248
Practice Address - Street 1:2055 E SOUTHERN AVE STE B
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7507
Practice Address - Country:US
Practice Address - Phone:480-704-3446
Practice Address - Fax:480-345-7248
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13939207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ231366Medicaid
AZ103884Medicare ID - Type Unspecified
AZ231366Medicaid