Provider Demographics
NPI:1730504150
Name:SHAH, KUNAL M
Entity type:Individual
Prefix:
First Name:KUNAL
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1406
Mailing Address - Country:US
Mailing Address - Phone:740-450-6175
Mailing Address - Fax:740-455-7632
Practice Address - Street 1:955 BETHESDA DR FL 1
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1840
Practice Address - Country:US
Practice Address - Phone:740-454-0804
Practice Address - Fax:740-454-7171
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68695207RC0000X
OH35.132462207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease