Individual
DR. SURENDRA J SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5825 BROADWAY, SUITE A, MERRILLVILLE, IN 46410-2687
(219) 884-1400
(219) 884-1453
Mailing address
5825 BROADWAY STE A, MERRILLVILLE, IN 46410-2664
(219) 884-1400
(219) 884-1453
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01032180
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100169840A
—
IN
Enumeration date
07/20/2006
Last updated
12/11/2020
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