Provider Demographics
NPI:1457367955
Name:SHIEH, MOSES KUN-CHI (DO)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:KUN-CHI
Last Name:SHIEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300 S CLEVELAND AVE
Mailing Address - Street 2:SUITE 56
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3886
Mailing Address - Country:US
Mailing Address - Phone:239-344-9786
Mailing Address - Fax:239-344-9215
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:SUITE 1300
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4367
Practice Address - Country:US
Practice Address - Phone:239-344-9786
Practice Address - Fax:239-344-9215
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43595208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75775727Medicaid
FL280678900Medicaid
CO75775727Medicaid
COI-16110Medicare UPIN
FLAJ338ZMedicare PIN