Provider Demographics
NPI:1245318443
Name:SHAH, SYED T (MD)
Entity type:Individual
Prefix:MR
First Name:SYED
Middle Name:T
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:345 FIRST SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:IA
Mailing Address - Zip Code:50682
Mailing Address - Country:US
Mailing Address - Phone:915-433-5362
Mailing Address - Fax:319-935-3331
Practice Address - Street 1:345 FIRST SOUTH STREET
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:IA
Practice Address - Zip Code:50682
Practice Address - Country:US
Practice Address - Phone:915-433-5362
Practice Address - Fax:319-935-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAAO2332Medicare UPIN