Healthcare Provider Details

I. General information

NPI: 1871541110
Provider Name (Legal Business Name): SHAUKAT ALI CHAUDHRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S MAIN ST STE 209
MISHAWAKA IN
46544-2160
US

IV. Provider business mailing address

303 S MAIN ST STE 209
MISHAWAKA IN
46544-2160
US

V. Phone/Fax

Practice location:
  • Phone: 574-255-4191
  • Fax: 574-259-8468
Mailing address:
  • Phone: 574-255-4191
  • Fax: 574-259-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1025631
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: