MEDICARE: SHEPHERDS INTERNAL MEDICINE PRACTICE

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	261QP2300X	Primary Care Clinic/Center	02003266A	IN

General Provider Information

NPI Number	:	1538464227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEPHERDS INTERNAL MEDICINE PRACTICE

Provider Business Mailing Address
First Line	:	7107 WILLIAMS CREEK DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3057
Country	:	US
Telephone Number	:	317-253-7559
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 WINTHROP AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1970
Country	:	US
Telephone Number	:	317-253-7559
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DAVID CARLTON SHEPHERD
Credential	:	D.O.
Telephone Number	:	317-253-7559

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	01/11/2011

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