Mukund Shah, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301039964 Issued in MI

Practice address

3800 Hollywood Rd
Suite 102
Saint Joseph, MI 49085-8510

Phone

(269) 428-2727

Fax

(269) 428-0377

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mshah1271905@epic00.shdirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mukund R Shah MD PLC

  • Pediatrics Physician
  • Saint Joseph, MI
  • NPI 1649440231
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013086446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 HOLLYWOOD RD",
            "address_2": "SUITE 102",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490858510",
            "telephone_number": "269-428-2727",
            "fax_number": "269-428-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 HOLLYWOOD RD",
            "address_2": "SUITE 102",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490858510",
            "telephone_number": "269-428-2727",
            "fax_number": "269-428-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "MUKUND",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301039964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1736679",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Esther R Servillas, MD
• Ryan Douglas Shafer
• Jayce Shaffer
• Aanal Shah, FNP-C
• Ami Shah, MD
• Riddhi Jay Shah, D.O.
• Shannon L Groh, Ma, LPC Counseling, PLLC
• Sharkey Chiropractic P.C.
• Kushagra Sharma
• Tushar D Sharma

• Pediatrics Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.