Provider Demographics
NPI:1023288230
Name:SHIPCHANDLER, TAHA Z (MD)
Entity type:Individual
Prefix:DR
First Name:TAHA
Middle Name:Z
Last Name:SHIPCHANDLER
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:
Mailing Address - Fax:
Practice Address - Street 1:11725 ILLINOIS ST STE 275
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3009
Practice Address - Country:US
Practice Address - Phone:317-948-5071
Practice Address - Fax:317-948-5144
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD68443207Y00000X
OH57.007689207Y00000X
IN01068324A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200987260Medicaid
MD417355400Medicaid
IN200987260Medicaid
MD417355400Medicaid
INP01019894Medicare PIN