Provider Demographics
NPI:1689641730
Name:SHAH, AJIT (MD)
Entity Type:Individual
Prefix:
First Name:AJIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24651 CENTER RIDGE RD
Mailing Address - Street 2:STE 350
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5635
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:7215 OLD OAK BLVD
Practice Address - Street 2:STE A 414
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-816-2782
Practice Address - Fax:440-816-8695
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-10-25
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Provider Licenses
StateLicense IDTaxonomies
OH35045151S207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040017966OtherRR MEDICARE INDIVIDUAL
CA4511OtherRR MEDICARE GROUP
OH0799864Medicaid
OH0799864Medicaid
CA4511OtherRR MEDICARE GROUP