Provider Demographics
NPI:1023074523
Name:SHINK, JILL LOUISE (DPM)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:LOUISE
Last Name:SHINK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WILDER RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2301
Mailing Address - Country:US
Mailing Address - Phone:989-667-4663
Mailing Address - Fax:989-667-1964
Practice Address - Street 1:3801 WILDER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2301
Practice Address - Country:US
Practice Address - Phone:989-667-4663
Practice Address - Fax:989-667-1964
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001781213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3346547Medicaid
MI0M22980001Medicare PIN
MI3346547Medicaid