MEDICARE: DR. RENE REVIS SHINGLES PH.D., ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1518939586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENE REVIS SHINGLES PH.D., ATC

Provider Business Mailing Address
First Line	:	1575 SCULLY RD
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-8011
Country	:	US
Telephone Number	:	989-773-9037
Fax Number	:

Provider Business Practice Location Address
First Line	:	HEALTH PROFESSIONS BUILDING 1171
Second Line	:	CENTRAL MICHIGAN UNIVERSITY
City	:	MT PLEASANT
State	:	MI
Zip	:	48859-0001
Country	:	US
Telephone Number	:	989-774-2378
Fax Number	:

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	07/08/2007

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