Individual
JONATHAN NEIL SHENK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5215 HOLY CROSS PKWY, EMERGENCY DEPARTMENT, MISHAWAKA, IN 46545-1469
(574) 335-5000
Mailing address
5215 HOLY CROSS PKWY, EMERGENCY DEPARTMENT, MISHAWAKA, IN 46545-1469
(574) 335-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01060154
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000361760
ANTHEM
IN
05
—
104743238
—
MI
05
—
200514100
—
IN
01
—
P00238236
RAIL ROAD MEDICARE
IN
Enumeration date
07/21/2005
Last updated
12/16/2011
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