Provider Demographics
NPI:1770565830
Name:CORNERSTONE FAMILY PHYSICIANS, P. C.
Entity type:Organization
Organization Name:CORNERSTONE FAMILY PHYSICIANS, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:317-581-8888
Mailing Address - Street 1:8902 N MERIDIAN ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5382
Mailing Address - Country:US
Mailing Address - Phone:317-581-8888
Mailing Address - Fax:317-705-7179
Practice Address - Street 1:8902 N MERIDIAN ST
Practice Address - Street 2:SUITE 230
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5382
Practice Address - Country:US
Practice Address - Phone:317-581-8888
Practice Address - Fax:317-705-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049047A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200379470AMedicaid
IN190530Medicare PIN
IN200379470AMedicaid
INCK2144Medicare PIN