Provider Demographics
NPI:1235129982
Name:SHEK, MITCHELL S (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:S
Last Name:SHEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 S ADAMS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7005
Mailing Address - Country:US
Mailing Address - Phone:248-646-9597
Mailing Address - Fax:248-646-4067
Practice Address - Street 1:800 S ADAMS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7005
Practice Address - Country:US
Practice Address - Phone:248-646-9597
Practice Address - Fax:248-646-4067
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407365207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070008143OtherMEDICARE RAILROAD
MI316769010Medicaid
MI316769010Medicaid
E49657Medicare UPIN