Provider Demographics
NPI:1447292206
Name:SHAH, RAKESH (MD)
Entity type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 BLOSSOM ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4228
Mailing Address - Country:US
Mailing Address - Phone:832-905-5940
Mailing Address - Fax:832-905-5941
Practice Address - Street 1:450 BLOSSOM ST
Practice Address - Street 2:SUITE D
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:832-905-5940
Practice Address - Fax:832-905-5941
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4707174400000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1505265-04Medicaid