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1619976602

NPI Code Detail

MEDICARE: SHRUTI ABHIJIT SHUKLA MD

MEDICARE: SHRUTI ABHIJIT SHUKLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZF0201X	Forensic Pathology Physician	01061384A	IN
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01061384A	IN

General Provider Information

NPI Number	:	1619976602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHRUTI ABHIJIT SHUKLA MD

Provider Business Mailing Address
First Line	:	200 HIGH PARK AVE
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-4810
Country	:	US
Telephone Number	:	574-533-2141
Fax Number	:	574-364-2777

Provider Business Practice Location Address
First Line	:	200 HIGH PARK AVE
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-4810
Country	:	US
Telephone Number	:	574-533-2141
Fax Number	:	574-364-2777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/03/2025

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Directions to “ SHRUTI ABHIJIT SHUKLA MD” Practice Location

Language	Start Address	Practice Location

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