Provider Demographics
NPI:1104117167
Name:KEPPLE, DREW A (MD)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:A
Last Name:KEPPLE
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-948-3200
Mailing Address - Fax:317-217-2424
Practice Address - Street 1:1351 RONALD REAGAN PKWY STE B
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6764
Practice Address - Country:US
Practice Address - Phone:317-948-3200
Practice Address - Fax:317-217-2424
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075030A208000000X, 208D00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201100060Medicaid
IN201100060Medicaid