Healthcare Provider Details

I. General information

NPI: 1316268816
Provider Name (Legal Business Name): HILLARY AGNES SHEMES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N MAIN ST
ITHACA MI
48847-1132
US

IV. Provider business mailing address

406 E ELM ST
CARSON CITY MI
48811-9693
US

V. Phone/Fax

Practice location:
  • Phone: 989-875-4166
  • Fax: 989-875-5168
Mailing address:
  • Phone: 989-584-3971
  • Fax: 989-584-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116022581
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101020719
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: