Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 58.031169 | OH |
Y | 111NI0900X | Internist | 58.031169 | OH |
NPI | 1003476268 |
---|---|
Provider Name | Chintan Shah |
First Address | Triadelphia, WV 26059-2426 |
Second Address | Olympia Fields, IL 60461-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2019 |
Last Update Date | 06/02/2020 |