Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT196623 | PA |
N | 111NI0900X | Internist | MT196623 | PA |
Y | 207RH0000X | Hematologist | 57086 | MN |
N | 207RH0003X | Hematology & Oncology | 106999 | MN |
N | 207RH0003X | Hematology & Oncology | 57086 | MN |
NPI | 1134449630 |
---|---|
Provider Name | Mithun Vinod Shah |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 20/08/2020 |