Individual
MATTHEW E SHAMBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7920 W JEFFERSON BLVD STE 200, FORT WAYNE, IN 46804-4166
(260) 490-7111
(260) 490-2286
Mailing address
7920 W JEFFERSON BLVD STE 200, FORT WAYNE, IN 46804-4166
(260) 490-7111
(260) 490-2286
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
01038077A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0852733
—
OH
05
—
100372030
—
IN
05
—
104366811
—
MI
01
—
240007527
MEDICARE RAILROAD
IN
Enumeration date
08/10/2005
Last updated
04/18/2017
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