Basic Information
| Provider Information | |||||||||
| NPI: | 1649286360 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | TUSHAR | ||||||||
| MiddleName: | KANTILAL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7255 OLD OAK BLVD STE C209 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408162777 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7255 OLD OAK BLVD # C209C | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408162777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 83450 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35.083450CTR | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 35.083450CTR | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 83450 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.