Provider Demographics
NPI:1396731931
Name:SHAH, PARESH (MD)
Entity type:Individual
Prefix:MR
First Name:PARESH
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 1:1008 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKTON
Mailing Address - State:IN
Mailing Address - Zip Code:46044-9783
Mailing Address - Country:US
Mailing Address - Phone:765-754-7557
Mailing Address - Fax:765-754-7140
Practice Address - Street 1:1008 HARRISON ST
Practice Address - Street 2:
Practice Address - City:FRANKTON
Practice Address - State:IN
Practice Address - Zip Code:46044-9783
Practice Address - Country:US
Practice Address - Phone:765-754-7557
Practice Address - Fax:765-754-7140
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038430207RA0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
INA15149Medicare UPIN
IN507600Medicare ID - Type Unspecified