Provider Demographics
NPI:1154742708
Name:BAY AREA HEART PLLC
Entity type:Organization
Organization Name:BAY AREA HEART PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-905-5940
Mailing Address - Street 1:450 BLOSSOM ST STE D
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4200
Mailing Address - Country:US
Mailing Address - Phone:832-905-5940
Mailing Address - Fax:832-905-5941
Practice Address - Street 1:450 BLOSSOM ST
Practice Address - Street 2:SUITE D
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:832-905-5940
Practice Address - Fax:832-905-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-29
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4707207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH59016Medicare UPIN
TXB27135Medicare UPIN