Individual
CHETAN R SHUKLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 566-2134
(317) 566-2058
Mailing address
PO BOX 7232, DEPT 118, INDIANAPOLIS, IN 46207-7232
(317) 567-2180
(317) 567-2191
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01048110A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
01048110A
IN
208VP0000X
Pain Medicine Physician
01048110A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200167200
—
IN
01
—
264430C09
MEDICARE PTAN
IN
01
—
Q00444063
RAILROAD PTAN
IN
Enumeration date
04/05/2006
Last updated
03/01/2024
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