Healthcare Provider Details

I. General information

NPI: 1528598489
Provider Name (Legal Business Name): ALLISON SHEWMAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MED CTR DR SPC 5718
ANN ARBOR MI
48109-5718
US

IV. Provider business mailing address

1500 E. MED. CTR. DR. SPC 5718
ANN ARBOR MI
48109-5718
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-5589
  • Fax: 734-763-4802
Mailing address:
  • Phone: 734-763-5589
  • Fax: 734-763-4802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301112609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: