| Shah Medical Clinic Prof Llc | |
|
6709 S Minnesota Ave Ste 200 Sioux Falls SD 57108-2593 | |
| (605) 275-0066 | |
| Not Available |
| Full Name | Shah Medical Clinic Prof Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6709 S Minnesota Ave Ste 200, Sioux Falls, South Dakota |
| Authorized Official Name and Position | Syeh Asif R Shah (OWNER) |
| Authorized Official Contact | 6052750066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shah Medical Clinic Prof Llc 6709 S Minnesota Ave Ste 200 Sioux Falls SD 57108-2593 Ph: (605) 275-0066 | Shah Medical Clinic Prof Llc 6709 S Minnesota Ave Ste 200 Sioux Falls SD 57108-2593 Ph: (605) 275-0066 |
| NPI Number | 1982042255 |
|---|---|
| Provider Enumeration Date | 06/10/2013 |
| Last Update Date | 06/10/2013 |
| Medicare PECOS PAC ID | 9335376649 |
|---|---|
| Medicare Enrollment ID | O20131212000532 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982042255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0537 (South Dakota) | Primary |
| Provider Name | Syed Asif R Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275514218 PECOS PAC ID: 9931192333 Enrollment ID: I20120215000258 |
| Provider Name | Elizabeth S Kruse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306194030 PECOS PAC ID: 8820249394 Enrollment ID: I20121119000583 |
| Provider Name | Dustin Allan Boes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629853536 PECOS PAC ID: 5294189395 Enrollment ID: I20230922002377 |
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