Provider Demographics
NPI:1215467550
Name:SHAH, BHRUGESH JOGESHKUMAR (MD)
Entity type:Individual
Prefix:
First Name:BHRUGESH
Middle Name:JOGESHKUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 SKY LARK LN UNIT 2018
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3739
Mailing Address - Country:US
Mailing Address - Phone:848-213-6617
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-7116
Practice Address - Fax:713-500-0625
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2023-03-01
Deactivation Date:2018-01-25
Deactivation Code:
Reactivation Date:2018-02-13
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10820200207R00000X
TXT8940208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine