Organization
WOLCOTT FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K SHIELDS MD (OWNER/PHYSICIAN)
(219) 279-2264
Entity
Organization
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
(219) 279-2264
(219) 279-2279
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027166A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100196860
—
IN
Enumeration date
08/09/2007
Last updated
09/30/2010
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