Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 01040024A | IN |
NPI | 1245209832 |
---|---|
Provider Name | Ketan K Sheth |
First Address | Lafayette, IN 47903-4699 |
Second Address | Lafayette, IN 47905-5760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100196140 | (05) | IN |
F24756 | (02) | IN |