Provider Demographics
NPI:1629715941
Name:SHAH, MOMIN (MD)
Entity Type:Individual
Prefix:
First Name:MOMIN
Middle Name:
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:THE UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE AND LIFE S
Mailing Address - Street 2:2100 W. CENTRAL AVE
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614
Mailing Address - Country:US
Mailing Address - Phone:567-420-1613
Mailing Address - Fax:
Practice Address - Street 1:TOLEDO HOSPITAL
Practice Address - Street 2:2142 NORTH COVE BOULEVARD
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:567-420-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program