Provider Demographics
NPI:1942201652
Name:SHETH, SUBHASH P (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHASH
Middle Name:P
Last Name:SHETH
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 1:7812 CREEKBOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5507
Mailing Address - Country:US
Mailing Address - Phone:502-428-4125
Mailing Address - Fax:
Practice Address - Street 1:1460 BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1272
Practice Address - Country:US
Practice Address - Phone:502-361-8496
Practice Address - Fax:502-361-3377
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22962207RX0202X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6590070600Medicaid
KY64229628Medicaid
KY6590070600Medicaid
KY64229628Medicaid