Shah, Surendra J
Shah, Surendra J is an individual health care provider with primary practice located at 5825 Broadway Suite A, Merrillville IN 46410-2687. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Shah, Surendra J can be contacted via phone (219) 884-1400.Contact Information
Primary practice address
5825 Broadway Suite A
Merrillville IN 46410-2687
Phone: (219) 884-1400
Fax: (219) 884-1453
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 01032180 | Indiana |
Profile Details
| NPI number | 1528088689 |
|---|---|
| LBN Legal business name | Shah, Surendra J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 20th, 2006 |
| Last updated | Dec 11th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528088689 | NPPES |
| Indiana | MEDICAID | 100169840A |
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