Individual
AMID SHAYESTEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1100 REID PARKWAY, EMERGENCY DEPARTMENT, RICHMOND, IN 47374-1157
(765) 983-3144
(765) 983-3038
Mailing address
1100 REID PARKWAY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 935-8807
(765) 983-3219
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02001165A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000031530
BLUE SHIELD - REID HOSP
IN
05
—
085200
—
OH
05
—
100367840
—
IN
Enumeration date
09/20/2006
Last updated
05/06/2014
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