Healthcare Provider Details

I. General information

NPI: 1932459567
Provider Name (Legal Business Name): GERALD A. SHIENER, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E MERRILL ST SUITE 230
BIRMINGHAM MI
48009-6121
US

IV. Provider business mailing address

251 E MERRILL ST SUITE 230
BIRMINGHAM MI
48009-6121
US

V. Phone/Fax

Practice location:
  • Phone: 248-645-5155
  • Fax: 248-645-2665
Mailing address:
  • Phone: 248-645-5155
  • Fax: 248-645-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4301036563
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301036563
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301036563
License Number StateMI

VIII. Authorized Official

Name: DR. GERALD A SHIENER
Title or Position: OWNER
Credential: M.D.
Phone: 248-645-5155