Healthcare Provider Details

I. General information

NPI: 1376595892
Provider Name (Legal Business Name): YUNUS M. SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2086 OLD HIGHWAY 135 NW
CORYDON IN
47112-4015
US

IV. Provider business mailing address

2086 OLD HIGHWAY 135 NW
CORYDON IN
47112-4015
US

V. Phone/Fax

Practice location:
  • Phone: 270-982-2714
  • Fax: 270-982-2717
Mailing address:
  • Phone: 812-734-0303
  • Fax: 812-225-5145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number37825
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01067073A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01067073A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: