Individual ProviderShaun MadaharInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address200 E Chestnut St, Service Building Suite 303, Louisville, KY 40202-1831(502) 629-5552(502) 272-5754PECOS EnrollmentBased on the most recent information from CMS, provider Shaun Madahar is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1013213776Provider TypeIndividualFull NameMadahar, ShaunCredentialM.D.GenderMaleSole ProprietorYesEnumeration Date1/28/2011Last Updated7/21/2022Contact InformationPractice LocationPractice Address200 E Chestnut St, Service Building Suite 303, Louisville, KY 40202-1831Phone(502) 629-5552Fax(502) 629-3132Mailing LocationMailing AddressPO Box 776351, Chicago, IL 60677-6351Phone(502) 272-5754Fax(502) 272-5339Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense46502KentuckyCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense127851CaliforniaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense0101254825VirginiaCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicense01076265AIndianaCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicenseMD454367PennsylvaniaProvider IdentifiersIDDescriptionIssuerID7100263820DescriptionMedicaidIssuerUnlistedKentucky