Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036122807 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA07771600 | NJ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 51640020 | WI |
NPI | 1073787065 |
---|---|
Provider Name | Dr. Michael Shin |
First Address | Spring Valley, IL 61362-1512 |
Second Address | Spring Valley, IL 61362-1512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 14/07/2009 |