Organization
SHANTHARAM SHETTY, MD MED PRO CORP,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTHARAM H SHETTY M.D. (PRESIDENT)
(812) 949-9918
Entity
Organization
Contact information
Practice address
1964 STATE ST STE 206, NEW ALBANY, IN 47150-4992
(812) 949-9918
(812) 949-9918
Mailing address
1964 STATE ST STE 206, NEW ALBANY, IN 47150-4992
(812) 949-9918
(812) 949-9918
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01031319A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100075510
—
IN
Enumeration date
09/21/2011
Last updated
10/03/2011
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