Provider Demographics
NPI:1821011594
Name:SHIN, PAUL Y (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:Y
Last Name:SHIN
Suffix:
Gender:M
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:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:114 EXECUTIVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4883
Practice Address - Country:US
Practice Address - Phone:765-446-5185
Practice Address - Fax:765-446-5186
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060949A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200800490Medicaid
IN200800490Medicaid
INH26045Medicare UPIN
IN220170EEMedicare PIN
IN815150001Medicare PIN