Provider Demographics
NPI:1548379191
Name:AHUJA, SHASHI K (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:K
Last Name:AHUJA
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 1:800 BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2149
Mailing Address - Country:US
Mailing Address - Phone:260-425-3133
Mailing Address - Fax:260-425-3110
Practice Address - Street 1:800 BROADWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2149
Practice Address - Country:US
Practice Address - Phone:260-425-3133
Practice Address - Fax:260-425-3110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027373A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100054800AMedicaid
IN100054800AMedicaid
IN141360AMedicare ID - Type Unspecified