Provider Demographics
NPI:1265638407
Name:RHOADS, SHIELA ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:ISAAC
Last Name:RHOADS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:1031 NEW MOODY LN
Practice Address - Street 2:SUITE 200
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9189
Practice Address - Country:US
Practice Address - Phone:502-222-6008
Practice Address - Fax:502-225-9878
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41339207R00000X, 207RG0100X
MI4301078487207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100015910Medicaid
KY7100015910Medicaid