Provider Demographics
NPI:1639168313
Name:SHIELDS, CHRISTOPHER B (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 1105
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-583-1609
Practice Address - Fax:502-583-2120
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY17534207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
102621OtherNNIKY/SIIHO
50022340OtherNNIKY/PASSPORT
000023035FOtherNNIKY/HUMANA
KY64175342Medicaid
P00739669OtherNNIKY/RAILROAD KY
0019138OtherNNIKY/CIGNA
36941900OtherNNIKY/PAD
102621OtherNNIKY/SIIHO
D32258Medicare UPIN
P00739669OtherNNIKY/RAILROAD KY