Provider Demographics
NPI:1801849997
Name:SHAH, MAHENDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3666
Mailing Address - Country:US
Mailing Address - Phone:505-727-3040
Mailing Address - Fax:505-727-3099
Practice Address - Street 1:8554 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7032
Practice Address - Country:US
Practice Address - Phone:219-750-9581
Practice Address - Fax:219-750-9781
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01029974207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82879257Medicaid
IN100202010AMedicaid
IN100202010AMedicaid