Provider Demographics
NPI:1265520837
Name:CHEN, LAN SHU (MD)
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:SHU
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DR
Mailing Address - Street 2:EH 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-274-8800
Mailing Address - Fax:317-274-2384
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:EH 125
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-274-8800
Practice Address - Fax:317-274-2384
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA457772084N0402X
IN01062646A2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A457770Medicaid
IN200866370Medicaid
CA00A457770 L59OtherCAL OPTIMA
IN262210UMedicare PIN
CA00A457770Medicaid
CAF35480Medicare UPIN