Individual
ANISH NITISH SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 741-1515
Mailing address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303
(765) 741-1515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01078995A
IN
207R00000X
Internal Medicine Physician
69222-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
125065115
IL
Other
Enumeration date
06/10/2014
Last updated
04/24/2018
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