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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

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SHIN, MIKE SHIBUM       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: 375TH MEDICAL GROUP/SGCQSL
ENT CLINIC 310 W LOSEY ST BLDG 1530
SCOTT AFB IL 62225-525
Phone #: (618) 256-7520
Fax #:
County: NOT OKLAHOMA
License: 22219
Dated: 1/5/2001
Expires: 1/1/2007
License Type: Medical Doctor
Specialty: Otolaryngology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Univ of TX at San Antonio, UTSA Long School of Medicine
Graduated: 5 / 1999
CME Year: 2007
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications:
New Patients: No
Medicaid: No
Medicare: No
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
375TH MEDICAL GROUP/SGCQSL
ENT CLINIC 310 W LOSEY ST BLDG 1530
SCOTT AFB IL 62225-525

Phone #: (618) 256-7520
Fax #:

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