Individual
JAMES K SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
128 W MARKET STREET, WOLCOTT, IN 47995
(219) 279-2264
(219) 279-2279
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027166A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000334269
ANTHEM PROVIDER NUMBER
IN
05
—
100196860
—
IN
Enumeration date
03/28/2006
Last updated
04/04/2012
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