Provider Demographics
NPI:1992115273
Name:SHUBIN, YEVHENIY (MD)
Entity type:Individual
Prefix:DR
First Name:YEVHENIY
Middle Name:
Last Name:SHUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:
Other - Last Name:SHUBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:611 E DOUGLAS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1468
Mailing Address - Country:US
Mailing Address - Phone:574-335-6242
Mailing Address - Fax:574-335-0758
Practice Address - Street 1:611 E DOUGLAS RD STE 401
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1468
Practice Address - Country:US
Practice Address - Phone:574-335-6242
Practice Address - Fax:574-335-0758
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078880A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics