MEDICARE: MATTHEW E SHAMBAUGH 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	208200000X	Plastic Surgery Physician	01038077A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240007527	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1700888617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW E SHAMBAUGH MD

Provider Business Mailing Address
First Line	:	7920 W JEFFERSON BLVD STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4166
Country	:	US
Telephone Number	:	260-490-7111
Fax Number	:	260-490-2286

Provider Business Practice Location Address
First Line	:	7920 W JEFFERSON BLVD STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4166
Country	:	US
Telephone Number	:	260-490-7111
Fax Number	:	260-490-2286

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/18/2017

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Directions to “ MATTHEW E SHAMBAUGH MD” Practice Location

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