Provider Demographics
NPI:1912952151
Name:MOKFI, SHAYA (MD)
Entity Type:Individual
Prefix:
First Name:SHAYA
Middle Name:
Last Name:MOKFI
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 1:14533 SEDGWICK CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4870
Mailing Address - Country:US
Mailing Address - Phone:574-855-4310
Mailing Address - Fax:574-855-4313
Practice Address - Street 1:15011 DAY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-4328
Practice Address - Country:US
Practice Address - Phone:574-855-4310
Practice Address - Fax:574-855-4313
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN021236800OtherFEDERAL BLACK LUNG
IN000000215942OtherBCBS
IN000000756923OtherBCBS HOSPITALIST
IN200171410AMedicaid
IN021236800OtherFEDERAL BLACK LUNG
INM400069464Medicare PIN
IN187720AMedicare PIN
IN000000756923OtherBCBS HOSPITALIST