Healthcare Provider Details

I. General information

NPI: 1518936079
Provider Name (Legal Business Name): JOSEPH RAYMOND SHINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 ST FRANCIS WAY STE 100
LAFAYETTE IN
47905-4917
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 765-428-5888
  • Fax: 765-428-5897
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number011047030A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: