Individual
DR. EDWIN J SHAKUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 N MADISON AVE, GREENWOOD, IN 46142-4135
(317) 888-3508
Mailing address
PO BOX 771846, DETROIT, MI 48278-1846
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01047025A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01047025A
INDIANA LICENSE
IN
01
—
01047025B
CSR
IN
Enumeration date
06/01/2005
Last updated
03/07/2023
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