Provider Demographics
NPI:1821084773
Name:SHAH, VIJAY P (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:P
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:311 E 89TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8126
Mailing Address - Country:US
Mailing Address - Phone:219-756-8400
Mailing Address - Fax:219-756-8001
Practice Address - Street 1:1400 S LAKE PARK AVE
Practice Address - Street 2:500
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6790
Practice Address - Country:US
Practice Address - Phone:219-942-7463
Practice Address - Fax:219-756-8001
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2009-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01044106207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200049440Medicaid
ING11881Medicare UPIN
IN192820 DMedicare ID - Type Unspecified
IN878190DMedicare PIN
IN200049440Medicaid