Provider Demographics
NPI:1548598345
Name:SHAH, MAHENDRA SARALAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:SARALAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1401 W LOCUST ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3275
Mailing Address - Country:US
Mailing Address - Phone:918-696-4065
Mailing Address - Fax:918-696-5971
Practice Address - Street 1:1401 W LOCUST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3275
Practice Address - Country:US
Practice Address - Phone:918-696-4065
Practice Address - Fax:918-696-5971
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK16375208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPENDING