Healthcare Provider Details

I. General information

NPI: 1013449032
Provider Name (Legal Business Name): THOMAS MAXWELL SHELTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD SUITE 220
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

535 BARNHILL DR # 150
INDIANAPOLIS IN
46202-5116
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-3700
  • Fax: 317-962-2893
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01087413A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: