Provider Information for 1205058344
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HEIDI SHOCK
Other Names:Other Name:HEIDI SHOCKSex: Female
NPI: 1205058344
Last Updated: 2023-08-09
Certification Date: 2023-08-09
Certification Date: 2023-08-09
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1205058344 | ||||||||||||
| Enumeration Date | 2007-05-02 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2000 HOGBACK RD STE 2 ANN ARBOR, MI 48105-9735 United States Phone: 734-386-0041 | Fax: | ||||||||||||
| Primary Practice Address | 2000 HOGBACK RD STE 2 ANN ARBOR, MI 48105-9735 United States Phone: 736-386-0041 | Fax: | ||||||||||||
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