MEDICARE: DR. JEFFREY M SHUSTER MD

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	207N00000X	Dermatology Physician	4301043096	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

General Provider Information

NPI Number	:	1730179946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY M SHUSTER MD

Provider Business Mailing Address
First Line	:	42633 GARFIELD RD
Second Line	:	SUITE 319
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5033
Country	:	US
Telephone Number	:	586-263-0777
Fax Number	:	586-263-5457

Provider Business Practice Location Address
First Line	:	42633 GARFIELD RD
Second Line	:	SUITE 319
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5033
Country	:	US
Telephone Number	:	586-263-0777
Fax Number	:	586-263-5457

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	06/25/2010

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