Individual
SHANNON D RIEGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
940 PARK EAST BLVD, LAFAYETTE, IN 47905-0792
(765) 464-2280
Mailing address
940 PARK EAST BLVD, MEDICAL STAFF SERVICES, LAFAYETTE, IN 47905
(765) 464-2280
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01044327A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000766379
ANTHEM
IN
05
—
200149450
—
IN
Enumeration date
02/23/2006
Last updated
02/07/2024
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