Provider Demographics
NPI:1144754771
Name:DESOUZA, SHIRIN RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:RUTH
Last Name:DESOUZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHIRIN
Other - Middle Name:RUTH
Other - Last Name:DEGIORGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-559-9295
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39514208000000X
CAA161675208000000X
KY55862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics