Provider Demographics
NPI:1972567147
Name:SHAH, KISHORI PIYUSH (MD)
Entity type:Individual
Prefix:DR
First Name:KISHORI
Middle Name:PIYUSH
Last Name:SHAH
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 1:2814 THEATER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-7978
Mailing Address - Country:US
Mailing Address - Phone:260-356-3611
Mailing Address - Fax:260-358-4263
Practice Address - Street 1:2814 THEATER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-7978
Practice Address - Country:US
Practice Address - Phone:260-356-3611
Practice Address - Fax:260-358-4263
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026610A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100467980BMedicaid
IN100467980BMedicaid
IND94795Medicare UPIN