Provider Demographics
NPI:1770914574
Name:KAREN T. SHIRRELL, MD
Entity type:Organization
Organization Name:KAREN T. SHIRRELL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHIRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-257-2076
Mailing Address - Street 1:1427 W 86TH ST
Mailing Address - Street 2:SUITE #152
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2103
Mailing Address - Country:US
Mailing Address - Phone:317-889-0635
Mailing Address - Fax:
Practice Address - Street 1:1427 W 86TH ST
Practice Address - Street 2:SUITE #152
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2103
Practice Address - Country:US
Practice Address - Phone:317-889-0635
Practice Address - Fax:317-889-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100126690Medicaid
INE80716Medicare UPIN