MEDICARE: JOSEPH RAYMOND SHINN 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	207V00000X	Obstetrics & Gynecology Physician	011047030A	IN

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
2	368474	OTHER	IN	PHCS PID NUMBER
3	10825939	OTHER	IN	CAQH NUMBER
4	000000806518	OTHER		ANTHEM

General Provider Information

NPI Number	:	1518936079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH RAYMOND SHINN MD

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	3920 ST FRANCIS WAY STE 100
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4917
Country	:	US
Telephone Number	:	765-428-5888
Fax Number	:	765-428-5897

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	09/20/2023

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Directions to “ JOSEPH RAYMOND SHINN MD” Practice Location

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