Provider Demographics
NPI:1093065377
Name:SHAVER, SAMUEL G (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:G
Last Name:SHAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3458
Practice Address - Country:US
Practice Address - Phone:765-298-5700
Practice Address - Fax:765-298-4913
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11016928A207Q00000X
IN01075554A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201097800Medicaid
INP01588256OtherRR MEDICARE
IN201097800Medicaid