Individual
KENNETH A SHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 MEDICAL ARTS BLVD, SUITE 100, ANDERSON, IN 46011-3459
(765) 298-5700
(765) 298-4913
Mailing address
5751 W 200 N, ANDERSON, IN 46011-9146
(765) 298-5706
(765) 298-4913
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01033608A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000313020
ANTHEM
IN
05
—
100172010
—
IN
Enumeration date
07/24/2006
Last updated
02/10/2021
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