Healthcare Provider Details

I. General information

NPI: 1851686968
Provider Name (Legal Business Name): MIDWEST EYE RETINA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 N ILLINOIS STREET SUITE 120
CARMEL IN
46032-9847
US

IV. Provider business mailing address

11220 ILLINOIS ST STE 120
CARMEL IN
46032-9847
US

V. Phone/Fax

Practice location:
  • Phone: 317-805-2200
  • Fax: 317-805-4579
Mailing address:
  • Phone: 317-805-2200
  • Fax: 317-805-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MILAN SHAH
Title or Position: OWNER
Credential: MD
Phone: 317-805-2200