Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901001781 | MI |
NPI | 1023074523 |
---|---|
Provider Name | Dr. Jill Louise Shink |
First Address | Bay City, MI 48706-2301 |
Second Address | Bay City, MI 48706-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 10/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3346547 | (05) | MI |
U58034 | (02) | MI |