MEDICARE: DR. JOSEFINA DIAZ SHEN 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	207R00000X	Internal Medicine Physician	036117976	IL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	4301101073	MI

General Provider Information

NPI Number	:	1477726917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEFINA DIAZ SHEN M.D.

Provider Business Mailing Address
First Line	:	245 STATE ST SE
Second Line	:	STE 1A
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4328
Country	:	US
Telephone Number	:	616-685-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 LAFAYETTE AVE SE
Second Line	:	STE 2045
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4692
Country	:	US
Telephone Number	:	616-685-3098
Fax Number	:	616-685-3095

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

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	07/06/2012

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