Basic Information
| Provider Information | |||||||||
| NPI: | 1043518244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEAH | ||||||||
| FirstName: | SANA | ||||||||
| MiddleName: | SHOAIB | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178658540 | ||||||||
| FaxNumber: | 3178658317 | ||||||||
| Practice Location | |||||||||
| Address1: | 761 45TH AVENUE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199223020 | ||||||||
| FaxNumber: | 2199223023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2011 | ||||||||
| LastUpdateDate: | 01/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 02004852A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 471400385 | 01 | IN | MEDICARE PTAN | OTHER |