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General NPI Number Information
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NPI Number | 1558252924
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Entity Type | Individual
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Provider Name | SHANE MICHAEL PITTMAN EMT-M
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 8520 ALLISON POINTE BLVD STE 223 PMB 99753
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City | INDIANAPOLIS
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State | IN
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Zip | 46250
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Country | US
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Telephone | 317-525-2520
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Fax |
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Provider Business Mailing Address
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Address Line | 8520 ALLISON POINTE BLVD STE 223 PMB 99753
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City | INDIANAPOLIS
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State | IN
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Zip | 46250
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number | 3251-2416-8453
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number | 3521-2416-8453
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 30018103
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License Number State | IN
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