Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 01031319A | IN |
NPI | 1013002245 |
---|---|
Provider Name | Mr. Shantharam H Shetty |
First Address | Louisville, KY 40222-4928 |
Second Address | New Albany, IN 47150-4990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 12/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100075510 | (05) | IN |
E13631 | (02) |