| Doctor Name: | RUSHABH ANILKUMAR SHAH |
| NPI Number: | 1033439989 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 4301096224 |
| Business Practice Address: | 1919 Lake Ave Suite 110 Plymouth, IN - 465637830 |
| Business Phone Number: | 5749413100 |
| Business Fax Number: | |
| Mailing Address: | Po Box 6309, SOUTH BEND |
| State: | IN |
| Postal Code: | 466606309 |
| Phone Number: | 5743358700 |
| Fax Number: | 5743350760 |
| NPI Enumeration Date: | 06/02/2010 |
| NPI Last Update Date: | 05/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 4301096224 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |