Healthcare Provider Details

I. General information

NPI: 1164347746
Provider Name (Legal Business Name): SHANE STEVEN MARKLE HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 E M 21
OWOSSO MI
48867-9039
US

IV. Provider business mailing address

1361 E M 21
OWOSSO MI
48867-9039
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-9377
  • Fax:
Mailing address:
  • Phone: 989-723-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3502013223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: