Provider Demographics
NPI:1104901644
Name:SHAH, MILAN (MD)
Entity type:Individual
Prefix:DR
First Name:MILAN
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 1:200 W 103RD ST STE 2040
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1007
Mailing Address - Country:US
Mailing Address - Phone:917-743-6959
Mailing Address - Fax:317-805-4579
Practice Address - Street 1:200 W 103RD ST STE 2040
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1007
Practice Address - Country:US
Practice Address - Phone:917-743-6959
Practice Address - Fax:317-805-4579
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065433A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200913050Medicaid
IN200913050Medicaid