Active NPI
Kenneth Daniel Shively, M.D.
- Family Medicine Physician
- Laporte, IN
National Provider Identifier
1932183449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01024055A
- Practice address
- 900 I St
Laporte, IN 46350-5533 - Phone
- (219) 324-1950
- NPI assigned
- Nov 30, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01024055A | IN | Primary |
Addresses
Primary practice location
900 I St
Laporte, IN 46350-5533
Mailing address
328 N Michigan St
Ste. 200
South Bend, IN 46601-1244
Phone (574) 647-1845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01024055A | IN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785628800000",
"number": "1932183449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 N MICHIGAN ST",
"address_2": "STE. 200",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011244",
"telephone_number": "574-647-1845",
"fax_number": "574-647-1825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 I ST",
"city": "LAPORTE",
"state": "IN",
"postal_code": "463505533",
"telephone_number": "219-324-1950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIVELY",
"first_name": "KENNETH",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-30",
"last_updated": "2026-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01024055A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laporte, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.