Basic Information
| Provider Information | |||||||||
| NPI: | 1770570178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SYED | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 ROSE ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405367001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 ROSE ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405369642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236047 | ||||||||
| FaxNumber: | 8592573873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 12/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37850 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 37850 | KY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 50010577 | 01 | KY | PASSPORT | OTHER | 1840658000 | 05 | WV | MEDICAID | 2568798 | 05 | OH | MEDICAID | 64068448 | 05 | KY | MEDICAID | 000000387593 | 01 | KY | BCBS | OTHER |