Provider Demographics
NPI:1356391403
Name:SHAH, SATISH K (MD)
Entity type:Individual
Prefix:
First Name:SATISH
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BLDG C STE 103
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-926-4281
Mailing Address - Fax:270-686-1820
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLDG C STE 103
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-926-4281
Practice Address - Fax:270-686-1820
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY250402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64250400Medicaid
KY1461601Medicare ID - Type Unspecified
KY64250400Medicaid