Provider Demographics
NPI:1841495405
Name:SHINER, KATHLEEN E (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:SHINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2305 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4649
Mailing Address - Country:US
Mailing Address - Phone:812-949-0405
Mailing Address - Fax:812-949-0445
Practice Address - Street 1:2305 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4649
Practice Address - Country:US
Practice Address - Phone:812-949-0405
Practice Address - Fax:812-949-0445
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01063763A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200868060AMedicaid