Healthcare Provider Details

I. General information

NPI: 1518341940
Provider Name (Legal Business Name): SIDDHARTH PARESH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CAPITOL AVE # E371
INDIANAPOLIS IN
46202-1218
US

IV. Provider business mailing address

1800 N CAPITOL AVE # E371
INDIANAPOLIS IN
46202-1218
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0700
  • Fax:
Mailing address:
  • Phone: 317-274-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036163615
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036163615
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036163615
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number04-53824
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number04-53824
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: