Healthcare Provider Details

I. General information

NPI: 1780886820
Provider Name (Legal Business Name): PIERRE NATHANIEL SHEPHERD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DRIVE 2ND FLOOR TAUBMAN CENTER RECP A
ANN ARBOR MI
48109-5326
US

IV. Provider business mailing address

700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5850
  • Fax: 734-764-4230
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301088496
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number069958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: