Provider Demographics
NPI:1609191139
Name:SCHIFFLI, EVAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:R
Last Name:SCHIFFLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 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:317-621-4139
Mailing Address - Fax:317-621-7885
Practice Address - Street 1:8101 CLEARVISTA PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256
Practice Address - Country:UM
Practice Address - Phone:317-621-5390
Practice Address - Fax:317-621-7885
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072247A207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01221106OtherRR MEDICARE PTAN
IN201094400Medicaid
INP01221106OtherRR MEDICARE PTAN