Organization
PEDIATRIC MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PIYUSH J SHAH MD (PRESIDENT)
(260) 356-3611
Entity
Organization
Contact information
Practice address
2814 THEATER AVE, HUNTINGTON, IN 46750-7978
(260) 356-3611
(260) 358-4263
Mailing address
2814 THEATER AVE, HUNTINGTON, IN 46750-7978
(260) 356-3611
(260) 358-4263
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100138140A
—
IN
Enumeration date
12/12/2006
Last updated
02/19/2013
Update your record
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