Provider Demographics
NPI:1770763153
Name:SHIVELY, JOHN CARROLL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARROLL
Last Name:SHIVELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3701 STATE ROAD 26 E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4808
Mailing Address - Country:US
Mailing Address - Phone:765-448-5800
Mailing Address - Fax:765-448-2032
Practice Address - Street 1:3701 STATE ROAD 26 E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4808
Practice Address - Country:US
Practice Address - Phone:765-448-5800
Practice Address - Fax:765-448-2032
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01032390A2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine