Provider Demographics
NPI:1548557275
Name:SHAH, MANISH MANSUKHLAL (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:MANSUKHLAL
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 1:4630 N HACIENDA DEL SOL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6017
Mailing Address - Country:US
Mailing Address - Phone:734-707-3960
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:DIVISION OF INPATIENT MEDICINE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5212
Practice Address - Country:US
Practice Address - Phone:520-626-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098795390200000X
AZ48617207R00000X, 207P00000X
ARE-11982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine