Provider Demographics
NPI:1548572977
Name:SHAH, HARDEEPAK (MD)
Entity Type:Individual
Prefix:
First Name:HARDEEPAK
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HARDEEPAK
Other - Middle Name:
Other - Last Name:SAINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8805 BRECKSVILLE RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1952
Mailing Address - Country:US
Mailing Address - Phone:216-369-2525
Mailing Address - Fax:
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:440-503-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097171207Q00000X
OH35-121981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine