Basic Information
| Provider Information | |||||||||
| NPI: | 1740452291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOOK | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8450 NORTHWEST BLVD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462781381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178022000 | ||||||||
| FaxNumber: | 3178022170 | ||||||||
| Practice Location | |||||||||
| Address1: | 13430 N MERIDIAN ST STE 367 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460321484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175752700 | ||||||||
| FaxNumber: | 3175752713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2008 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 01065236 | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200908900 | 05 | IN | MEDICAID |