Healthcare Provider Details

I. General information

NPI: 1447875976
Provider Name (Legal Business Name): PATRIC G SHAMOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N MACOMB ST
MONROE MI
48162-7815
US

IV. Provider business mailing address

718 N MACOMB ST
MONROE MI
48162-7815
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-8400
  • Fax:
Mailing address:
  • Phone: 734-240-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301507709
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301507709
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: