MEDICARE: TAISEER JUMHA SHATARA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	01039660A	IN

General Provider Information

NPI Number	:	1548252463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAISEER JUMHA SHATARA MD

Provider Business Mailing Address
First Line	:	8424 NAAB RD
Second Line	:	3-J
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1975
Country	:	US
Telephone Number	:	317-872-7396
Fax Number	:	317-879-8328

Provider Business Practice Location Address
First Line	:	8424 NAAB RD
Second Line	:	3-J
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1975
Country	:	US
Telephone Number	:	317-872-7396
Fax Number	:	317-879-8328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	10/23/2007

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Directions to “ TAISEER JUMHA SHATARA MD” Practice Location

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