MEDICARE: DR. S. CHRISTOPHER SHIM 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
1	2084P0800X	Psychiatry Physician	01035698A	IN

General Provider Information

NPI Number	:	1588676415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. S. CHRISTOPHER SHIM M.D.

Provider Business Mailing Address
First Line	:	11012 W SYCAMORE HILLS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9308
Country	:	US
Telephone Number	:	260-615-1216
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 E COOK RD STE 500
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-3657
Country	:	US
Telephone Number	:	260-969-9696
Fax Number	:	260-969-7979

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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