Healthcare Provider Details

I. General information

NPI: 1093356545
Provider Name (Legal Business Name): SHIM MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12780 RACE TRACK RD STE 200
TAMPA FL
33626-1395
US

IV. Provider business mailing address

12780 RACE TRACK RD STE 200
TAMPA FL
33626-1395
US

V. Phone/Fax

Practice location:
  • Phone: 813-814-9251
  • Fax: 813-814-9261
Mailing address:
  • Phone: 813-814-9251
  • Fax: 813-814-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN H. SHIM
Title or Position: PRESIDENT
Credential: MD
Phone: 813-814-9251