Provider Information for 1801945324
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Dr. SCOTT D. SHAW D.Min.
Sex: Male
NPI: 1801945324
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
Name | Value | ||||||||||||
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NPI | 1801945324 | ||||||||||||
Enumeration Date | 2007-01-10 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 3501 LAKE EASTBROOK BLVD SE SUITE 280 GRAND RAPIDS, MI 49546-5938 United States Phone: 616-942-7331 | Fax:616-942-8807 | ||||||||||||
Primary Practice Address | 3501 LAKE EASTBROOK BLVD SE SUITE 280 GRAND RAPIDS, MI 49546-5938 United States Phone: 616-942-7331 | Fax:616-942-8807 | ||||||||||||
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