Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 01054170A | IN |
NPI | 1013961333 |
---|---|
Provider Name | Dr. Rajendra Vito Shah |
First Address | South Bend, IN 46601-1003 |
Second Address | South Bend, IN 46601-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 10/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200359270A | (05) | IN |
H49654 | (02) |