Provider Demographics
NPI:1922009109
Name:SHIRRELL, KAREN T (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:T
Last Name:SHIRRELL
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:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-0793
Mailing Address - Country:US
Mailing Address - Phone:317-257-2076
Mailing Address - Fax:317-889-0635
Practice Address - Street 1:13824 MILLSTONE CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9116
Practice Address - Country:US
Practice Address - Phone:317-574-9724
Practice Address - Fax:317-466-3091
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100126690AMedicaid
IN000000087978OtherANTHEM
IN314080Medicare ID - Type Unspecified
IN000000087978OtherANTHEM