Provider Demographics
NPI:1427058825
Name:SHAHER, MOTAZ M (MD)
Entity type:Individual
Prefix:
First Name:MOTAZ
Middle Name:M
Last Name:SHAHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOTAZ
Other - Middle Name:M
Other - Last Name:ALSHAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5165 MCCARTY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8764
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-838-4333
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070641A207R00000X, 207RC0000X
VA0101276464207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200478170Medicaid
IN200478170Medicaid
INI04496Medicare UPIN
KY0366687Medicare ID - Type Unspecified
KY64081680Medicaid