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NPI Code Detail

MEDICARE: DR. JON ANDREW SHULL M.D.

MEDICARE: DR. JON ANDREW SHULL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician01064025AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013948348
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JON ANDREW SHULL M.D.
Provider Business Mailing Address
First Line : 3355 DOUGLAS RD
Second Line : SUITE 300
City : SOUTH BEND
State : IN
Zip : 46635-1781
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1708 HIGH ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46613-2633
Country : US
Telephone Number : 574-647-1400
Fax Number : 574-237-6663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 10/28/2009

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Directions to “ DR. JON ANDREW SHULL M.D.” Practice Location

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