Provider Demographics
NPI:1285606327
Name:SHET, PRAKASH SHIVARM (MD)
Entity type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:SHIVARM
Last Name:SHET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3367
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-3367
Mailing Address - Country:US
Mailing Address - Phone:502-813-6664
Mailing Address - Fax:502-813-6665
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:#610
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-813-6611
Practice Address - Fax:502-813-6650
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY397302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200821460Medicaid
KY64114747Medicaid
KY378851OtherTRICARE
KY0878430Medicare PIN
KY64114747Medicaid
KYP00459304Medicare PIN