Provider Demographics
NPI:1790770790
Name:SHEETS, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:SHEETS
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 1:9998 CROSSPOINT BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036089A2085R0202X
IN10360892085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300059732OtherRAILROAD MEDICARE
IN100320790AMedicaid
IN000000109948OtherANTHEM
IN300059732OtherRAILROAD MEDICARE
IN222750XMedicare PIN
INE83523Medicare UPIN
IN151720VMedicare PIN
IN151970QMedicare PIN
IN152520ZMedicare PIN
IN191630QMedicare PIN
151700KKMedicare PIN
IN822400NMedicare ID - Type Unspecified
IN150890QMedicare PIN
IN100320790AMedicaid
152690TMedicare PIN
185550RMedicare PIN
IN151540TMedicare PIN
151560YMedicare PIN
152410ZMedicare PIN
IN152870QMedicare PIN
IN151950SMedicare PIN