Provider Demographics
NPI:1306814587
Name:SHIUE, KATHERINE M (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:SHIUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 MID RIVERS MALL DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2820
Mailing Address - Country:US
Mailing Address - Phone:636-441-5437
Mailing Address - Fax:636-441-4398
Practice Address - Street 1:4525 MID RIVERS MALL DR
Practice Address - Street 2:SUITE 20
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63376-2820
Practice Address - Country:US
Practice Address - Phone:636-441-5437
Practice Address - Fax:636-441-4398
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113981208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1306814587Medicaid
H26387Medicare UPIN