Provider Demographics
NPI:1912188988
Name:KIM P. SCHERSCHEL M.D. FAAFP
Entity Type:Organization
Organization Name:KIM P. SCHERSCHEL M.D. FAAFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SCHERSCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-279-4477
Mailing Address - Street 1:2424 Q ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-4734
Mailing Address - Country:US
Mailing Address - Phone:812-279-4477
Mailing Address - Fax:812-275-0088
Practice Address - Street 1:2424 Q ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4734
Practice Address - Country:US
Practice Address - Phone:812-279-4477
Practice Address - Fax:812-275-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ1032022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN221640Medicare PIN