MEDICARE: KIM PETER SCHERSCHEL 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	174400000X	Specialist	01032022	IN
2	207Q00000X	Family Medicine Physician	01032022	IN
3	207P00000X	Emergency Medicine Physician	01032022A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000602256	OTHER	IN	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000086054	OTHER	IN	BC BS ID NUJMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720082597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM PETER SCHERSCHEL MD

Provider Business Mailing Address
First Line	:	8840 COMMERCE PARK PL STE E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520A Q ST
Second Line	:
City	:	BEDFORD
State	:	IN
Zip	:	47421-4928
Country	:	US
Telephone Number	:	812-279-4477
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/08/2016

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Directions to “ KIM PETER SCHERSCHEL MD” Practice Location

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