Provider Demographics
NPI:1538166988
Name:K DONALD SHELBOURNE MD LLC
Entity type:Organization
Organization Name:K DONALD SHELBOURNE MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:K
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:SHELBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-924-8636
Mailing Address - Street 1:1815 N CAPITOL AVE
Mailing Address - Street 2:STE 530
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1288
Mailing Address - Country:US
Mailing Address - Phone:317-924-8636
Mailing Address - Fax:317-921-0230
Practice Address - Street 1:1815 N CAPITOL AVE
Practice Address - Street 2:STE 600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1288
Practice Address - Country:US
Practice Address - Phone:317-924-8636
Practice Address - Fax:317-921-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027165A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADB9030OtherRAILROAD MEDICARE
IN220130Medicare PIN
GADB9030OtherRAILROAD MEDICARE
IN215630Medicare PIN