Provider Demographics
NPI:1831185560
Name:SHIN, DONALD S (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:S
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 1:6208 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2409
Mailing Address - Country:US
Mailing Address - Phone:734-421-8600
Mailing Address - Fax:734-421-5889
Practice Address - Street 1:6208 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2409
Practice Address - Country:US
Practice Address - Phone:734-421-8600
Practice Address - Fax:734-421-5889
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5198819Medicaid
MI5198819Medicaid
MI0P47610001Medicare PIN