Healthcare Provider Details

I. General information

NPI: 1700921996
Provider Name (Legal Business Name): ELIAN MICHAEL SHEPHERD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 BROADWAY
MERRILLVILLE IN
46410-7046
US

IV. Provider business mailing address

101 E 87TH AVE
MERRILLVILLE IN
46410-7335
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-2255
  • Fax: 219-738-2060
Mailing address:
  • Phone: 219-738-2255
  • Fax: 219-738-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01033705A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: