Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 02005978A | IN |
N | 111NI0900X | Internist | 02005978A | IN |
N | 207R00000X | Internist | 34.012545 | OH |
N | 111NI0900X | Internist | 34.012545 | OH |
Y | 207RC0000X | Internist - Cardiovascular Disease | 02005978A | IN |
NPI | 1013332857 |
---|---|
Provider Name | Ankur Shah |
First Address | Indianapolis, IN 46260-1992 |
Second Address | Indianapolis, IN 46260-1992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2014 |
Last Update Date | 13/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0254672 | (05) | OH |