Provider Demographics
NPI:1255407045
Name:SHRIFT, MICHAEL SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:SHRIFT
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 1:303 CONGRESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5631
Mailing Address - Country:US
Mailing Address - Phone:612-305-8247
Mailing Address - Fax:
Practice Address - Street 1:697 PRO MED LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5323
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN514432084P0800X
CO310362084P0800X
IN01074131A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000884694OtherANTHEM
IN000000884696OtherANTHEM
IN000000884693OtherANTHEM HIP/ANTHEM MEDICAID
IN000000884693OtherANTHEM
IN201235550Medicaid
IN000000884693OtherANTHEM HIP/ANTHEM MEDICAID
IN000000884694OtherANTHEM
IN266180380Medicare PIN
MNF7519Medicare UPIN