Provider Demographics
NPI:1285955401
Name:SHAH, KUSHAL J (MD)
Entity type:Individual
Prefix:
First Name:KUSHAL
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13345 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3318
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-352-3417
Practice Address - Street 1:555 E COUNTY LINE RD STE 202
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1063
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:317-317-3418
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2022-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01078267A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01078267AOtherMD LICENSE