Provider Demographics
NPI:1821090085
Name:SHAH, HIMANSHU (MD)
Entity Type:Individual
Prefix:DR
First Name:HIMANSHU
Middle Name:
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 1:3700 BELLEMEADE AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0106
Mailing Address - Country:US
Mailing Address - Phone:812-437-4333
Mailing Address - Fax:812-437-4335
Practice Address - Street 1:801 SAINT MARYS DR
Practice Address - Street 2:SUITE 502 EAST
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0511
Practice Address - Country:US
Practice Address - Phone:812-485-1785
Practice Address - Fax:812-485-1890
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036039A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100122510CMedicaid
IN100122510CMedicaid