Individual
BHUPENDRA K SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2452 LAKE AVE, FORT WAYNE, IN 46805-5406
(260) 422-9494
(260) 422-9142
Mailing address
PO BOX 12409, FORT WAYNE, IN 46863-2409
(260) 422-9494
(260) 422-9142
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01030038A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100079820A
—
IN
Enumeration date
07/12/2005
Last updated
06/28/2009
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