Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 4301044306 | MI |
NPI | 1043285489 |
---|---|
Provider Name | Thomas R Shaw |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 28/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1558407189 | GROUP NPI (01) | MI |
1677700 | (05) | MI |
3504126341 | BCBS (01) | MI |
A79646 | (02) | MI |