Provider Demographics
NPI:1073786521
Name:GAILUSHAS, SHANE A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:A
Last Name:GAILUSHAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MERCY EAR NOSE AND THROAT CLINIC
Mailing Address - Street 2:901 8TH AVENUE SE
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401
Mailing Address - Country:US
Mailing Address - Phone:319-398-6900
Mailing Address - Fax:319-398-6901
Practice Address - Street 1:MERCY EAR NOSE AND THROAT CLINIC
Practice Address - Street 2:901 8TH AVENUE SE
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401
Practice Address - Country:US
Practice Address - Phone:319-398-6900
Practice Address - Fax:319-398-6901
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-43426207YX0905X
MTMED-PHYS-LIC-33185207YX0905X
WI53757-20207YX0905X
MO2013015482207YX0905X
NMMD2015-0203207YX0905X
UT8995595-1205207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1073786521Medicaid