Provider Information for 1912290875
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MICHAEL TODD SHOOK
Sex: Male
NPI: 1912290875
Last Updated: 2020-10-26
Certification Date: 2020-10-26
Certification Date: 2020-10-26
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1912290875 | ||||||||||||
| Enumeration Date | 2011-05-25 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 200 TURWILL LN KALAMAZOO, MI 49006-4277 United States Phone: 269-344-4413 | Fax: | ||||||||||||
| Primary Practice Address | 625 E. LIBERTY ST STE.205 ANN ARBOR, MI 48104 United States Phone: 269-352-9315 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 200 TURWILL LN | ||||||||||||
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