Provider Demographics
NPI:1003787920
Name:SHUMUNOV, MICHELLE (CNM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SHUMUNOV
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1437
Mailing Address - Country:US
Mailing Address - Phone:248-693-0543
Mailing Address - Fax:248-693-3683
Practice Address - Street 1:32686 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0951
Practice Address - Country:US
Practice Address - Phone:248-645-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704431857176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife