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General NPI Number Information
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NPI Number | 1093757478
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Entity Type | Organization
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Legal Business Name | EMGI CLARIAN WEST, LLC
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 1111 RONALD REAGAN PKWY
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City | AVON
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State | IN
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Zip | 46123-7085
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Country | US
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Telephone | 317-802-3146
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Fax |
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Provider Business Mailing Address
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Address Line | 2449 RELIABLE PARKWAY
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City | CHICAGO
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State | IL
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Zip | 60686-0001
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Country | US
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Telephone | 317-802-3146
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Fax | 317-870-0499
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES SHUFFLEBARGER
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Credential | MD
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Telephone | 317-802-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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