Healthcare Provider Details

I. General information

NPI: 1609712975
Provider Name (Legal Business Name): SHOSHANA HALLOWELL MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 DIXIE HWY
WATERFORD MI
48329-1615
US

IV. Provider business mailing address

3195 OXFORD W
AUBURN HILLS MI
48326-3966
US

V. Phone/Fax

Practice location:
  • Phone: 407-919-8667
  • Fax:
Mailing address:
  • Phone: 407-919-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHOSHANA HALLOWELL
Title or Position: GENERAL SURGEON
Credential: MD
Phone: 407-919-8667