Healthcare Provider Details

I. General information

NPI: 1801251194
Provider Name (Legal Business Name): SHATTUCK FAMILY PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W CARO RD
CARO MI
48723-9686
US

IV. Provider business mailing address

1525 W CARO RD
CARO MI
48723-9686
US

V. Phone/Fax

Practice location:
  • Phone: 989-860-0088
  • Fax:
Mailing address:
  • Phone: 989-865-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NAVEED MAHFOOZ
Title or Position: OWNER
Credential: MD
Phone: 989-672-2100