MEDICARE: PAUL C SHIN MD

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	35062801	OH
2	208VP0014X	Interventional Pain Medicine Physician	35.062801	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1164425807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL C SHIN MD

Provider Business Mailing Address
First Line	:	970 E WASHINGTON ST
Second Line	:	5A
City	:	MEDINA
State	:	OH
Zip	:	44256-3332
Country	:	US
Telephone Number	:	330-721-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 E WASHINGTON ST
Second Line	:	5A
City	:	MEDINA
State	:	OH
Zip	:	44256-3332
Country	:	US
Telephone Number	:	330-721-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2005
Last Update Date	:	10/07/2014

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Directions to “ PAUL C SHIN MD” Practice Location

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