Provider Demographics
NPI:1336172394
Name:SHEDD, PHILIPPA ME (MD)
Entity Type:Individual
Prefix:MRS
First Name:PHILIPPA
Middle Name:ME
Last Name:SHEDD
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 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-375-3000
Mailing Address - Fax:812-375-3477
Practice Address - Street 1:4001 W GOELLER BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8309
Practice Address - Country:US
Practice Address - Phone:812-375-3330
Practice Address - Fax:812-375-3329
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051048207Q00000X
IN01051048A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000991449OtherANTHEM PIN
IN200174010Medicaid
IN000000991449OtherANTHEM PIN
IN200174010Medicaid
INM400027585Medicare PIN