Provider Demographics
NPI:1114186798
Name:CHARLES C SHIN MD INC
Entity Type:Organization
Organization Name:CHARLES C SHIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-816-2730
Mailing Address - Street 1:7225 OLD OAK BLVD
Mailing Address - Street 2:SUITE B312
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3377
Mailing Address - Country:US
Mailing Address - Phone:440-816-2730
Mailing Address - Fax:440-816-5352
Practice Address - Street 1:7225 OLD OAK BLVD
Practice Address - Street 2:SUITE B312
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3377
Practice Address - Country:US
Practice Address - Phone:440-816-2730
Practice Address - Fax:440-816-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35100181207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0387764Medicaid
OHB95382Medicare UPIN
OHSH0440801Medicare PIN
OH0900640001Medicare NSC