Individual
JOSEPH RAYMOND SHINN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3920 ST FRANCIS WAY STE 100, LAFAYETTE, IN 47905-4917
(765) 428-5888
(765) 428-5897
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
011047030A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000806518
ANTHEM
—
01
—
10825939
CAQH NUMBER
IN
05
—
200154140
—
IN
01
—
368474
PHCS PID NUMBER
IN
Enumeration date
03/16/2006
Last updated
09/20/2023
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