Provider Demographics
NPI:1558367839
Name:SHAH, BIVIK R (MD)
Entity Type:Individual
Prefix:DR
First Name:BIVIK
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6499 E BROAD ST
Mailing Address - Street 2:STE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6506
Mailing Address - Country:US
Mailing Address - Phone:614-322-2500
Mailing Address - Fax:614-322-2532
Practice Address - Street 1:6499 E BROAD ST
Practice Address - Street 2:STE 130
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6506
Practice Address - Country:US
Practice Address - Phone:614-322-2500
Practice Address - Fax:614-322-2532
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2013-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-06-9188-S208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH17303Medicare UPIN
OHSH4023057Medicare PIN
OHSH4023057Medicare ID - Type Unspecified