Provider Demographics
NPI:1780640995
Name:PEMA, SHITAL (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHITAL
Middle Name:
Last Name:PEMA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2405
Mailing Address - Country:US
Mailing Address - Phone:937-298-7351
Mailing Address - Fax:937-298-9458
Practice Address - Street 1:4441 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2405
Practice Address - Country:US
Practice Address - Phone:937-298-7351
Practice Address - Fax:937-298-9458
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003246P213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2222080Medicaid
0285440006Medicare NSC
4196294Medicare PIN
OH4196292Medicare PIN
OH4039948Medicare PIN
OH4039949Medicare PIN
OHU83367Medicare UPIN
480032188Medicare PIN
OH4196291Medicare PIN
OH2222080Medicaid
0285440005Medicare NSC
0285440007Medicare NSC
OH4196293Medicare PIN
OH4039945Medicare PIN