Individual ProviderShiva GauchanInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address11109 Parkview Plaza Dr., Fort Wayne, IN 46845-1701(260) 672-6620PECOS EnrollmentBased on the most recent information from CMS, provider Shiva Gauchan 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 3 days ago.Profile DetailsProvider ID1275811457Provider TypeIndividualFull NameGauchan, ShivaTitleDr.CredentialM.D.GenderMaleSole ProprietorYesEnumeration Date7/22/2011Last Updated10/20/2022Contact InformationPractice LocationPractice Address11109 Parkview Plaza Dr., Fort Wayne, IN 46845-1701Phone(260) 672-6620Fax(260) 672-6639Mailing LocationMailing Address11109 Parkview Plaza Dr # 117, Fort Wayne, IN 46845-1701PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense01070823AIndianaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicense125055779IllinoisCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicense036128601IllinoisProvider IdentifiersIDDescriptionIssuerID000000766040DescriptionOtherIssuerANTHEMIndiana