Individual
RUSHABH ANILKUMAR SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1919 LAKE AVE, SUITE 110, PLYMOUTH, IN 46563-7830
(574) 948-5290
(574) 948-5495
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01072555A
IN
208000000X
Pediatrics Physician
4301096224
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201166310
—
IN
Enumeration date
06/02/2010
Last updated
11/16/2023
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