Provider Demographics
NPI:1184617789
Name:SHETH, MADHUSUDAN T (MD,)
Entity type:Individual
Prefix:DR
First Name:MADHUSUDAN
Middle Name:T
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 1:16173 LIBBY RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1245
Mailing Address - Country:US
Mailing Address - Phone:216-662-3040
Mailing Address - Fax:216-662-3870
Practice Address - Street 1:16173 LIBBY RD
Practice Address - Street 2:
Practice Address - City:MAPLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1245
Practice Address - Country:US
Practice Address - Phone:216-662-3040
Practice Address - Fax:216-662-3870
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH038621S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000130920OtherUNICARE
OH000000130920OtherANTHEM BLUE SHIELD
OH0329175Medicaid
OH010048866OtherRAILROAD MEDICARE
OH000000130920OtherUNICARE
OH010048866OtherRAILROAD MEDICARE