Dr. Yogendra a. Shah, MD. SC

Primary specialty

SpecialistTaxonomy code 174400000X

License

036048989 Issued in IL

Legal business name

DR. YOGENDRA A. SHAH, MD. SC

Practice address

3165 Myrtle Ave
Granite City, IL 62040-5012

Phone

(618) 451-7717

Fax

(618) 451-7780

NPI assigned

Jun 20, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Yogendra Ambalal Shah, M.D.

Title

GYN

Phone

(618) 451-7717

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1386907707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 MYRTLE AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405012",
            "telephone_number": "618-451-7717",
            "fax_number": "618-451-7780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3165 MYRTLE AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405012",
            "telephone_number": "618-451-7717",
            "fax_number": "618-451-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. YOGENDRA A. SHAH, MD. SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "YOGENDRA",
        "authorized_official_middle_name": "AMBALAL",
        "authorized_official_title_or_position": "GYN",
        "authorized_official_telephone_number": "618-451-7717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036048989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036048989",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Granite City, IL
• Providers in Granite City, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.