Provider Demographics
NPI:1992754329
Name:SHAH, VIPUL RAMANLAL (MD)
Entity type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:RAMANLAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 48947
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0125
Mailing Address - Country:US
Mailing Address - Phone:813-579-0313
Mailing Address - Fax:902-460-6312
Practice Address - Street 1:10311 CROSS CREEK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2989
Practice Address - Country:US
Practice Address - Phone:813-994-7670
Practice Address - Fax:813-994-7640
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0462Medicare ID - Type Unspecified
FLH81116Medicare UPIN