Basic Information
| Provider Information | |||||||||
| NPI: | 1073995049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | RAJ | ||||||||
| MiddleName: | SUBHASH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 SW 160TH AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542136251 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3601 SW 160TH AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778667123 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2015 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.147247 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 125067856 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | ME139688 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.