Provider Demographics
NPI:1285642629
Name:HARRISON, TINA L (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:L
Other - Last Name:SCHMEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-6333
Mailing Address - Fax:317-621-6310
Practice Address - Street 1:9669 E. 146TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5004
Practice Address - Country:US
Practice Address - Phone:317-621-6300
Practice Address - Fax:317-621-6310
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051078A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200307830Medicaid
IN000000312975OtherANTHEM
INP00138522OtherMEDICARE RAILROAD
IN215270BMedicare PIN
IN000000312975OtherANTHEM
INM400029897Medicare PIN