Provider Demographics
NPI:1811980717
Name:SHAH, BHARAT J (MD)
Entity type:Individual
Prefix:
First Name:BHARAT
Middle Name:J
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 1:11125 DUNN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-839-5522
Mailing Address - Fax:314-839-5351
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-839-5522
Practice Address - Fax:314-839-5351
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3A49207RC0000X
IL036064312207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1993V3831OtherGHP/CMR
4040666OtherAETNA
1475257OtherCIGNA
103383OtherHLNK
MO27888OtherMOBS/BLCHOICE
42760V30946OtherHLTHPART
IL060067911OtherILRRMCR
2509028OtherUHC
000000013077OtherESSENCE
A29082OtherMERCY
MO060015451OtherMORRMCR
10095V8816OtherHCUSA
MO201865219Medicaid
MO002011207Medicare PIN
000000013077OtherESSENCE
1993V3831OtherGHP/CMR
2509028OtherUHC
ILL86362Medicare PIN
MO002013908Medicare PIN
MO27888OtherMOBS/BLCHOICE