Healthcare Provider Details

I. General information

NPI: 1649262494
Provider Name (Legal Business Name): ROBERT E SHOEMAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 N SHADELAND AVE SUITE 200
INDIANAPOLIS IN
46250-2693
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-8500
  • Fax: 317-621-8501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01026362A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: