Provider Demographics
NPI:1669421921
Name:SHAH, MEHUL P (MD)
Entity type:Individual
Prefix:DR
First Name:MEHUL
Middle Name:P
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2149 E BASELINE RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1539
Mailing Address - Country:US
Mailing Address - Phone:480-345-0034
Mailing Address - Fax:480-345-4033
Practice Address - Street 1:2149 E BASELINE RD
Practice Address - Street 2:SUITE #103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1539
Practice Address - Country:US
Practice Address - Phone:480-345-0034
Practice Address - Fax:480-345-4033
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2020-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ27343207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ462490Medicaid
AZ77124Medicare PIN
AZ462490Medicaid