Provider Demographics
NPI:1275502213
Name:CAUDY, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CAUDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 W RAMPART ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-421-2012
Mailing Address - Fax:317-398-1851
Practice Address - Street 1:2451 INTELLIPLEX DR
Practice Address - Street 2:STE 260
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176
Practice Address - Country:US
Practice Address - Phone:317-398-0121
Practice Address - Fax:317-398-0538
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2020-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01054873A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0617185Medicaid
IN200325230Medicaid
G39942Medicare UPIN
IN179720Medicare PIN
080173416Medicare PIN
IN172580OMedicare PIN