Provider Demographics
NPI:1508975434
Name:SECHRIST, KEETER D (MD)
Entity Type:Individual
Prefix:
First Name:KEETER
Middle Name:D
Last Name:SECHRIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 E 82ND ST
Mailing Address - Street 2:#75
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7335
Mailing Address - Country:US
Mailing Address - Phone:317-926-3739
Mailing Address - Fax:317-921-7478
Practice Address - Street 1:11900 N PENNSYLVANIA ST
Practice Address - Street 2:#202
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4693
Practice Address - Country:US
Practice Address - Phone:317-926-3739
Practice Address - Fax:317-921-7478
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030264A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100335170AMedicaid
IN061500BMedicare ID - Type UnspecifiedMEDICARE ID
IN100335170AMedicaid