Provider Demographics
NPI:1376595892
Name:SHAH, YUNUS M (MD)
Entity Type:Individual
Prefix:
First Name:YUNUS
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2086 OLD HIGHWAY 135 NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON,
Mailing Address - State:IN
Mailing Address - Zip Code:47112-4015
Mailing Address - Country:US
Mailing Address - Phone:812-734-0303
Mailing Address - Fax:812-225-5145
Practice Address - Street 1:2086 OLD HIGHWAY 135 NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-4015
Practice Address - Country:US
Practice Address - Phone:270-982-2714
Practice Address - Fax:270-982-2717
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37825207L00000X
IN01067073A207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200438790Medicaid
KY64066558Medicaid
KY64066558Medicaid
KY0239920Medicare PIN
KYP400033461Medicare PIN
IN547260LLMedicare PIN
KY00629008Medicare PIN
INM53407010Medicare PIN