Surendra J Shah PC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

01032180A Issued in IN

Legal business name

SURENDRA J SHAH PC

Practice address

5825 Broadway
Suite a
Merrillville, IN 46410-2687

Phone

(219) 884-1400

Fax

(219) 884-1453

NPI assigned

Nov 1, 2007

Last updated

Dec 18, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Surendra J Shah, M.D.NPI 1528088689

Title

Owner

Phone

(219) 884-1400

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Surendra J Shah, M.D.

  • Internal Medicine Physician
  • Merrillville, IN
  • NPI 1528088689
  Authorized official Same address or phone
• Francisco Acevedo Jr., APRN, CNP

  • Nurse Practitioner
  • Mokena, IL
  • NPI 1467446930
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1437338829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5825 BROADWAY",
            "address_2": "SUITE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464102687",
            "telephone_number": "219-884-1400",
            "fax_number": "219-884-1453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5825 BROADWAY",
            "address_2": "SUITE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464102687",
            "telephone_number": "219-884-1400",
            "fax_number": "219-884-1453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURENDRA J SHAH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "SURENDRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-884-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "IN",
            "license": "01032180A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Geriatric Medicine (Internal Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.