MEDICARE: RACHEL ANN SHOCKLEY DO

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	207Q00000X	Family Medicine Physician	02002899A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01292380	OTHER	IN	MEDICARE RR PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000004901	OTHER	IN	ANTHEM LEGACY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699724393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ANN SHOCKLEY DO

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10122 E 10TH ST
Second Line	:	SUITE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2663
Country	:	US
Telephone Number	:	317-355-5913
Fax Number	:	317-355-3760

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/27/2023

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Directions to “ RACHEL ANN SHOCKLEY DO” Practice Location

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