Healthcare Provider Details

I. General information

NPI: 1023252665
Provider Name (Legal Business Name): NAMRATA SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY STE B1500
AVON IN
46123-7085
US

IV. Provider business mailing address

801 N STATE ST
GREENFIELD IN
46140-1270
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-2244
  • Fax: 317-217-2249
Mailing address:
  • Phone: 317-462-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2015-0598
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD2015-0598
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS000-6337-9938
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01081834A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: