Provider Demographics
NPI:1548329675
Name:SHINDER, MICHAEL H (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:SHINDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3038
Mailing Address - Country:US
Mailing Address - Phone:215-332-5300
Mailing Address - Fax:215-332-5228
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-332-5300
Practice Address - Fax:215-332-5228
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002652L213E00000X
NJ25MD00157000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ467940MNCMedicare PIN
NJ467940MNWMedicare PIN
T28363Medicare UPIN
PA087219MNAMedicare ID - Type Unspecified