Provider Demographics
NPI:1477501351
Name:SHAH, JIGNESH S (MD)
Entity type:Individual
Prefix:
First Name:JIGNESH
Middle Name:S
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-1775
Mailing Address - Fax:503-494-4749
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-1775
Practice Address - Fax:503-494-4749
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD219046207RC0000X, 207RC0001X
TXV5940207R00000X, 207RC0001X
VA0101266000207RC0001X
KY36788207RC0001X, 207RC0000X
CODR.0053517207RC0000X, 207RC0001X
OH35.098235207RC0000X
WI74061207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100022238Medicaid
OH3080419Medicaid
WV3810011973Medicaid
KYP00865267OtherMEDICARE RAILROAD
KY7100063450Medicaid
KY8447492Medicaid
CO95076255Medicaid
KYP400025150Medicare PIN
KYK135670Medicare PIN
KY153010Medicare UPIN
KY8447492Medicaid
CO95076255Medicaid
OHH054801Medicare PIN