Individual
HUSAIN YUSUF SHAATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-7636
Mailing address
RCS PROVIDER ENROLLMENT, 1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(317) 963-1093
(317) 968-1316
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01083394A
IN
2084N0400X
Neurology Physician
60 P89836
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300038594
—
IN
01
—
815500402
MEDICARE PTAN
IN
Enumeration date
08/27/2013
Last updated
03/14/2024
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