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General NPI Number Information
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NPI Number | 1386852010
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Entity Type | Individual
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Provider Name | THOMAS A SHIN MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 05/09/2017
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Provider Practice Location Address
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Address Line | 430 WARRENVILLE RD
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City | LISLE
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State | IL
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Zip | 60532-1348
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Country | US
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Telephone | 630-432-6745
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Fax | 630-432-6608
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Provider Business Mailing Address
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Address Line | 1860 PAYSHERE CIR
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City | CHICAGO
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State | IL
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Zip | 60674-2807
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Country | US
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Telephone | 219-836-9024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 0101236094
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 01064613A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 036119760
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License Number State | IL
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