Provider Demographics
NPI:1891758272
Name:LAMB, SHANNON S (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:S
Last Name:LAMB
Suffix:
Gender:F
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:PO BOX 2368
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2368
Mailing Address - Country:US
Mailing Address - Phone:812-474-1110
Mailing Address - Fax:812-474-1303
Practice Address - Street 1:700 N BURKHARDT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2740
Practice Address - Country:US
Practice Address - Phone:812-474-1110
Practice Address - Fax:812-471-9282
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010333742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100319830Medicaid
IL3300262019Medicaid
360003672OtherRR MEDICARE TA
KY64756281Medicaid
IN259540EMedicare PIN
IL3300262019Medicaid
KY00549002Medicare PIN
C43311Medicare UPIN
IN838350CMedicare PIN