Provider Demographics
NPI:1982683736
Name:SHAO, FRANK (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:SHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ZHENGWEI
Other - Middle Name:
Other - Last Name:SHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1720 BEACON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4749
Practice Address - Country:US
Practice Address - Phone:260-373-8000
Practice Address - Fax:260-373-8034
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057139A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000543922OtherANTHEM
OH2566094Medicaid
IN200431980Medicaid
INP00041676OtherRAILROAD MEDICARE
IN14436OtherPHYSICIANS HEALTH PLAN
INP00466959OtherRAILROAD MEDICARE
IN200431980Medicaid
OH2566094Medicaid
IN070860KKKMedicare PIN