Provider Demographics
NPI:1982042255
Name:SHAH MEDICAL CLINIC PROF LLC
Entity Type:Organization
Organization Name:SHAH MEDICAL CLINIC PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYEH
Authorized Official - Middle Name:ASIF R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-275-0066
Mailing Address - Street 1:6709 S MINNESOTA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2593
Mailing Address - Country:US
Mailing Address - Phone:605-275-0066
Mailing Address - Fax:
Practice Address - Street 1:6709 S MINNESOTA AVE STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2593
Practice Address - Country:US
Practice Address - Phone:605-275-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty