Provider Demographics
NPI:1588975643
Name:SHAH, DHAVAL MAHESH (MD)
Entity type:Individual
Prefix:
First Name:DHAVAL
Middle Name:MAHESH
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 1:2149 E BASELINE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1539
Mailing Address - Country:US
Mailing Address - Phone:480-345-0034
Mailing Address - Fax:480-345-4033
Practice Address - Street 1:2149 E BASELINE RD STE 103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1539
Practice Address - Country:US
Practice Address - Phone:480-345-0034
Practice Address - Fax:480-345-4033
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258477207R00000X
AZ54078207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease