Provider Demographics
NPI:1558252924
Name:PITTMAN, SHANE MICHAEL (EMT-M)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:MICHAEL
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:EMT-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 ALLISON POINTE BLVD STE 223
Mailing Address - Street 2:PMB 99753
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8520 ALLISON POINTE BLVD STE 223
Practice Address - Street 2:PMB 99753
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-525-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3251-2416-84531710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians