Basic Information
| Provider Information | |||||||||
| NPI: | 1649381690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHATAGOPAM | ||||||||
| FirstName: | RAMESH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478074214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423175 | ||||||||
| FaxNumber: | 8122423543 | ||||||||
| Practice Location | |||||||||
| Address1: | 1429 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122320564 | ||||||||
| FaxNumber: | 8122423543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 01048847A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 36111955 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0182822 | 01 | US DEPT OF LABOR | OTHER | 471334 | 01 | HEALTHLINK | OTHER | P00855812 | 01 | IN | RAILROAD MEDICARE | OTHER | P00828502 | 01 | IN | RAILROAD MEDICARE | OTHER | 200374390 | 05 | IN | MEDICAID | 778240 | 01 | AETNA | OTHER | P00393763 | 01 | RAILROAD MEDICARE | OTHER | 7690262001 | 01 | CIGNA | OTHER | 200374390Z | 05 | IN | MEDICAID | N289136 | 01 | HARMONY HEALTH PLAN IND | OTHER | 200374390L | 05 | IN | MEDICAID | 351904269120 | 01 | CARESOURCE MEDICAID | OTHER | 7789240 | 01 | AETNA | OTHER | 000000224022 | 01 | ANTHEM | OTHER | 060068689 | 01 | RAILROAD MCARE PALAMETTO | OTHER | 200374390A | 01 | IN | MOLINA HEALTHCARE MCAID | OTHER |