MEDICARE: DR. SHEILA MOTHKUR M.D.

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	174400000X	Specialist	01037546	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235228818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEILA MOTHKUR M.D.

Provider Business Mailing Address
First Line	:	1501 WABASH ST STE 101
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4364
Country	:	US
Telephone Number	:	219-874-5333
Fax Number	:	219-874-0254

Provider Business Practice Location Address
First Line	:	1501 WABASH ST STE 101
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4364
Country	:	US
Telephone Number	:	219-874-5333
Fax Number	:	219-874-0254

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/15/2009

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