Provider Demographics
NPI:1972501328
Name:SHAH, ALKA MAYANK (MD)
Entity Type:Individual
Prefix:
First Name:ALKA
Middle Name:MAYANK
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 NICKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-1739
Mailing Address - Country:US
Mailing Address - Phone:937-773-0012
Mailing Address - Fax:937-773-3712
Practice Address - Street 1:821 NICKLIN AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-1739
Practice Address - Country:US
Practice Address - Phone:937-773-0012
Practice Address - Fax:937-773-3712
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038331S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0366143Medicaid
OH0366143Medicaid
OHC01527Medicare UPIN