Provider Demographics
NPI:1871539585
Name:SHEPICH, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:SHEPICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6187
Mailing Address - Country:US
Mailing Address - Phone:989-631-6710
Mailing Address - Fax:919-631-8583
Practice Address - Street 1:4007 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6187
Practice Address - Country:US
Practice Address - Phone:989-631-6710
Practice Address - Fax:919-631-8583
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS059228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3379092Medicaid
MI3379092Medicaid
G54745Medicare UPIN