MEDICARE: MRS. PHILIPPA M.E SHEDD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01051048	IN
2	207Q00000X	Family Medicine Physician	01051048A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000991449	OTHER	IN	ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336172394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHILIPPA M.E SHEDD MD

Provider Business Mailing Address
First Line	:	PO BOX 775383
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5383
Country	:	US
Telephone Number	:	812-375-3000
Fax Number	:	812-375-3477

Provider Business Practice Location Address
First Line	:	4001 W GOELLER BLVD STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-8309
Country	:	US
Telephone Number	:	812-375-3330
Fax Number	:	812-375-3329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	10/28/2020

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