Provider Demographics
NPI:1720082597
Name:SCHERSCHEL, KIM PETER (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:PETER
Last Name:SCHERSCHEL
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 1:8840 COMMERCE PARK PL STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2520A Q ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4928
Practice Address - Country:US
Practice Address - Phone:812-279-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032022174400000X, 207Q00000X
IN01032022A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000602256OtherBLUE SHIELD
IN100166860AMedicaid
IN000000086054OtherBC BS ID NUJMBER
IN100166860DMedicaid
IN100166860AMedicaid
IN100166860DMedicaid
IN221640Medicare PIN
IN131180SSSMedicare PIN