Individual
MITRA SHAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6041 TIMBER RIDGE DR, PROSPECT, KY 40059-8134
(502) 228-2225
(502) 228-2226
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 238-2801
(502) 238-2835
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
40284
KY
207R00000X
Internal Medicine Physician
TP723
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000699132
ANTHEM - NCMA
KY
01
—
000057058T
HUMANA - NCMA
KY
01
—
121562
SIHO - NCMA
KY
05
—
200859040
—
IN
01
—
50031915
PASSPORT & PP ADVTG - NCMA
KY
05
—
7100020180
—
KY
01
—
7659346
CIGNA - NCMA
KY
01
—
P00893048
RAILROAD MEDICARE - KY
KY
Enumeration date
09/25/2006
Last updated
11/29/2012
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