Healthcare Provider Details

I. General information

NPI: 1215919519
Provider Name (Legal Business Name): PAUL S SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26025 LAHSER RD 2ND FLOOR
SOUTHFIELD MI
48033-2601
US

IV. Provider business mailing address

26025 LAHSER RD 2ND FLOOR
SOUTHFIELD MI
48033-2601
US

V. Phone/Fax

Practice location:
  • Phone: 248-663-1900
  • Fax: 248-663-1902
Mailing address:
  • Phone: 248-663-1900
  • Fax: 248-663-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301069354
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4301069354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: