Basic Information
| Provider Information | |||||||||
| NPI: | 1811980717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | BHARAT | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11125 DUNN RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148395522 | ||||||||
| FaxNumber: | 3148395351 | ||||||||
| Practice Location | |||||||||
| Address1: | 11125 DUNN RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148395522 | ||||||||
| FaxNumber: | 3148395351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 02/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | R3A49 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 036064312 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1993V3831 | 01 | GHP/CMR | OTHER | 4040666 | 01 | AETNA | OTHER | 1475257 | 01 | CIGNA | OTHER | 103383 | 01 | HLNK | OTHER | 27888 | 01 | MO | MOBS/BLCHOICE | OTHER | 42760V30946 | 01 | HLTHPART | OTHER | 060067911 | 01 | IL | ILRRMCR | OTHER | 2509028 | 01 | UHC | OTHER | 000000013077 | 01 | ESSENCE | OTHER | A29082 | 01 | MERCY | OTHER | 060015451 | 01 | MO | MORRMCR | OTHER | 10095V8816 | 01 | HCUSA | OTHER | 201865219 | 05 | MO | MEDICAID |