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NPI Code Detail

MEDICARE: JONATHAN STEPHEN SHAW M.D.

MEDICARE: JONATHAN STEPHEN SHAW 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
1207VF0040XUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianEMC0002741MI
2207V00000XObstetrics & Gynecology Physician18596NH
3207V00000XObstetrics & Gynecology PhysicianEMC0002741MI

Other Identifiers

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

General Provider Information

NPI Number : 1356672794
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN STEPHEN SHAW M.D.
Provider Business Mailing Address
First Line : PO BOX 776982
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6982
Country : US
Telephone Number : 800-494-5797
Fax Number :
Provider Business Practice Location Address
First Line : 6401 PRAIRIE ST STE 1700
Second Line :
City : NORTON SHORES
State : MI
Zip : 49444-7843
Country : US
Telephone Number : 231-672-7944
Fax Number : 231-672-7994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2010
Last Update Date : 08/10/2023

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