Provider Demographics
NPI:1700884319
Name:BAKER, SHELBY J (NP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 E STOP 11 RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6340
Mailing Address - Country:US
Mailing Address - Phone:317-882-2857
Mailing Address - Fax:317-882-2873
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 355
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-924-8420
Practice Address - Fax:317-924-6785
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28072072207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000323346OtherANTHEM NUMBER
IN076330VMedicare ID - Type UnspecifiedMEDICARE NUMBER
IN000000323346OtherANTHEM NUMBER