Individual
DR. JON ANDREW SHULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1708 HIGH ST, SOUTH BEND, IN 46613-2633
(574) 647-1400
(574) 237-6663
Mailing address
3355 DOUGLAS RD, SUITE 300, SOUTH BEND, IN 46635-1781
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01064025A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200872740
—
IN
Enumeration date
07/05/2006
Last updated
10/28/2009
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