Individual
DR. KISHAN MITESH SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1353 PASEO DEL PUEBLO SUR STE D, TAOS, NM 87571-5958
(575) 613-8090
(575) 613-8091
Mailing address
7300 RANCH ROAD 2222, BLDG 1, STE 200, AUSTIN, TX 78730
(512) 628-0465
(512) 233-2711
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
DR.0072048
CO
207N00000X
Dermatology Physician
Primary
MD2024-0189
NM
Other
Enumeration date
04/01/2019
Last updated
10/24/2024
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