Healthcare Provider Details

I. General information

NPI: 1003228545
Provider Name (Legal Business Name): KEVIN REN-YEH SHIUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE # AG117
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-1315
  • Fax:
Mailing address:
  • Phone: 317-944-1315
  • Fax: 317-944-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11017627A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01082152A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: