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General NPI Number Information
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NPI Number | 1043310329
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Entity Type | Individual
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Provider Name | MITRA SHAMS MD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 6041 TIMBER RIDGE DR
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City | PROSPECT
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State | KY
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Zip | 40059-8134
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Country | US
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Telephone | 502-228-2225
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Fax | 502-228-2226
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Provider Business Mailing Address
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Address Line | PO BOX 950248
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City | LOUISVILLE
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State | KY
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Zip | 40295-0248
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Country | US
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Telephone | 502-238-2801
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Fax | 502-238-2835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TP723
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 40284
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License Number State | KY
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