Roger K Shieh, DDS
Individual provider Active NPI Dentist · Lake Station, IN
NPI 1144540980 · NPPES record last updated May 26, 2016
Key facts
- NPI
- 1144540980
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12011455A (IN)
- Practice address
- 3099 Central Ave
Lake Station, IN 46405-2207 - Phone
- (219) 763-8112
- Fax
- (219) 764-5384
- NPI assigned
- Jun 3, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160614002404 | IN | Order and Referring Only - Dentist |
7719278191 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12011455A | IN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12011455A | IN | Yes |
Addresses
Primary practice location
3099 Central Ave
Lake Station, IN 46405-2207
Mailing address
PO Box 1430
Portage, IN 46368-9230
Phone (219) 763-8112
Other providers in Lake Station, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.