=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497232136
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS SHI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2018
-----------------------------------------------------
Last Update Date | 07/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 339 WINDERMERE ROAD
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | N6A3N6
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone | 519-685-8500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 339 WINDERMERE ROAD
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | N6A3N6
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0101X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology Physician
-----------------------------------------------------
License Number | 105918
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------