Individual
SHAMIRAM BADAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2930 W CLEVELAND RD, SOUTH BEND, IN 46628-6090
(574) 335-8450
(574) 335-0760
Mailing address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-8700
(574) 335-0760
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A113428
CA
390200000X
Student in an Organized Health Care Education/Training Program
125053883
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000789617
BCBS
IN
01
—
000000856561
BCBS NW
IN
01
—
01070305A
IN STATE ID
IN
01
—
125053883
STATE LICENSE
IL
05
—
201073880
—
IN
Enumeration date
01/20/2009
Last updated
01/13/2026
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