Provider Demographics
NPI:1104358555
Name:SHAH, RUCHIT
Entity type:Individual
Prefix:
First Name:RUCHIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 S DOBSON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4726
Mailing Address - Country:US
Mailing Address - Phone:480-733-7535
Mailing Address - Fax:480-896-3374
Practice Address - Street 1:1520 S DOBSON RD STE 203
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4726
Practice Address - Country:US
Practice Address - Phone:480-733-7535
Practice Address - Fax:480-896-3374
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75264207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology