Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 5101012993 | MI |
NPI | 1164466223 |
---|---|
Provider Name | Dr. Michael Bradley Shingles |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-5376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 22/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164466223 | (05) | MI |
4322272 | (05) | MI |
H51261 | (02) | MI |