| Chandrakant Shah Md Pa | |
|
13033 Sw 112th St Miami FL 33186-4601 | |
| (305) 382-4901 | |
| (305) 382-4502 |
| Full Name | Chandrakant Shah Md Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 13033 Sw 112th St, Miami, Florida |
| Authorized Official Name and Position | Chandrakant S Shad (PRESIDENT) |
| Authorized Official Contact | 3053824901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chandrakant Shah Md Pa 13033 Sw 112th St Miami FL 33186-4601 Ph: (305) 382-4901 | Chandrakant Shah Md Pa 13033 Sw 112th St Miami FL 33186-4601 Ph: (305) 382-4901 |
| NPI Number | 1790940138 |
|---|---|
| Provider Enumeration Date | 07/24/2008 |
| Last Update Date | 08/26/2008 |
| Medicare PECOS PAC ID | 1052472354 |
|---|---|
| Medicare Enrollment ID | O20081204000891 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790940138 | NPI | - | NPPES |
| 14792 | Other | FL | MEDICARE ID |
| 058773703 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0061676 (Florida) | Primary |
| Provider Name | Chandrakant S Shah |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1073689634 PECOS PAC ID: 4789745076 Enrollment ID: I20081204000813 |
| Provider Name | Yajaira Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982915245 PECOS PAC ID: 7012137441 Enrollment ID: I20141006002100 |
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