Provider Demographics
NPI:1588667372
Name:SHAH, SUBHASH H (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:H
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 1:220 S HILLSIDE ST STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2151
Mailing Address - Country:US
Mailing Address - Phone:316-686-6866
Mailing Address - Fax:316-686-9797
Practice Address - Street 1:220 S HILLSIDE ST STE A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2151
Practice Address - Country:US
Practice Address - Phone:316-686-6866
Practice Address - Fax:316-686-9797
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24004174400000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100136270BMedicaid
F11945Medicare UPIN
KS100136270BMedicaid