Basic Information
| Provider Information | |||||||||
| NPI: | 1881893741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SAMIR | ||||||||
| MiddleName: | RAMESHCHANDRA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 S DADELAND BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331562866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054684185 | ||||||||
| FaxNumber: | 3055963073 | ||||||||
| Practice Location | |||||||||
| Address1: | 5803 NW 151ST ST STE 105 | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330142473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055963080 | ||||||||
| FaxNumber: | 3055963073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 38018 | SC | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 38018 | SC | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | ME140999 | FL | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.