Provider Demographics
NPI:1811101512
Name:SHAH, RISHIN D (MD)
Entity type:Individual
Prefix:
First Name:RISHIN
Middle Name:D
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5760 LEGACY DR
Mailing Address - Street 2:STE B3-424
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7102
Mailing Address - Country:US
Mailing Address - Phone:972-391-1940
Mailing Address - Fax:972-391-2061
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:SUITE 536
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:972-378-9560
Practice Address - Fax:972-378-9561
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ4693207RI0011X
NY262983207R00000X
IL036.124200207R00000X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349774503Medicaid
TX349774501Medicaid
TX349774502Medicaid
TX438592YSN3Medicare PIN
TX438592YU6XMedicare PIN
TX438592YSHRMedicare PIN