Individual
PRAKASH SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1724 KENTON ST, STE 1D, HOPKINSVILLE, KY 42240-1981
(270) 887-9066
(270) 887-9199
Mailing address
1724 KENTON ST, STE 1D, HOPKINSVILLE, KY 42240-1981
(270) 887-9066
(270) 887-9199
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31011
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050781
ANTHEM
KY
01
—
110090936
MEDICARE RAILROAD
KY
01
—
1902803513
NPI
—
05
—
64310113
—
KY
01
—
7493
MEDICARE GROUP
KY
Enumeration date
06/29/2005
Last updated
05/21/2015
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