Provider Demographics
NPI:1588676415
Name:SHIM, S. CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:S.
Middle Name:CHRISTOPHER
Last Name:SHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11012 W SYCAMORE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9308
Mailing Address - Country:US
Mailing Address - Phone:260-615-1216
Mailing Address - Fax:
Practice Address - Street 1:415 E COOK RD STE 500
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3657
Practice Address - Country:US
Practice Address - Phone:260-969-9696
Practice Address - Fax:260-969-7979
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035698A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
INA16833Medicare UPIN
IN190330Medicare ID - Type Unspecified