Provider Demographics
NPI:1972587863
Name:REKHA SHAH MD PC
Entity type:Organization
Organization Name:REKHA SHAH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:VIKRAM
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-899-8774
Mailing Address - Street 1:1726 E KNOX RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3330
Mailing Address - Country:US
Mailing Address - Phone:480-899-8774
Mailing Address - Fax:480-345-7248
Practice Address - Street 1:2971 W ELLIOT RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1636
Practice Address - Country:US
Practice Address - Phone:480-899-8774
Practice Address - Fax:480-345-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-04
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13939207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ231366Medicaid
AZWMBTS01Medicare ID - Type UnspecifiedMEDICARE NUMBER
AZ231366Medicaid