Provider Demographics
NPI:1598192544
Name:SHAH MEDICAL CONSULTING LLC
Entity Type:Organization
Organization Name:SHAH MEDICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAYED
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-340-8979
Mailing Address - Street 1:2206 E 52ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2790
Mailing Address - Country:US
Mailing Address - Phone:563-340-8979
Mailing Address - Fax:
Practice Address - Street 1:2206 E 52ND ST STE A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2790
Practice Address - Country:US
Practice Address - Phone:563-340-8979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35468OtherIA LICENSE
IL036110953OtherIL LICENSE
IL036110953OtherIL LICENSE