Healthcare Provider Details

I. General information

NPI: 1326241266
Provider Name (Legal Business Name): THOMAS WOO SHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7895 GRAND BLVD
HOBART IN
46342-6665
US

IV. Provider business mailing address

7895 GRAND BLVD
HOBART IN
46342-6665
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-1910
  • Fax: 219-947-3117
Mailing address:
  • Phone: 219-947-1910
  • Fax: 219-947-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01075481A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: