Provider Demographics
NPI:1124452180
Name:SHAATH, HUSAIN YUSUF (MD)
Entity type:Individual
Prefix:
First Name:HUSAIN
Middle Name:YUSUF
Last Name:SHAATH
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:RCS PROVIDER ENROLLMENT
Mailing Address - Street 2:1200 W WHITE RIVER BLVD
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:317-963-1093
Mailing Address - Fax:317-968-1316
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7636
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 P898362084N0400X
IN01083394A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300038594Medicaid
IN815500402OtherMEDICARE PTAN