MEDICARE: ELIZABETH MARY SHADIGIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301064081	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083803993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARY SHADIGIAN M.D.

Provider Business Mailing Address
First Line	:	2340 E STADIUM BLVD
Second Line	:	SUITE 8
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4823
Country	:	US
Telephone Number	:	734-477-5100
Fax Number	:	734-477-5111

Provider Business Practice Location Address
First Line	:	2340 E STADIUM BLVD
Second Line	:	SUITE 8
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4823
Country	:	US
Telephone Number	:	734-477-5100
Fax Number	:	734-477-5111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/16/2007

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