Healthcare Provider Details

I. General information

NPI: 1326890666
Provider Name (Legal Business Name): PAPNEZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 N WIXOM RD
WIXOM MI
48393-1411
US

IV. Provider business mailing address

1545 N WIXOM RD
WIXOM MI
48393-1411
US

V. Phone/Fax

Practice location:
  • Phone: 248-833-6343
  • Fax: 248-833-6343
Mailing address:
  • Phone: 248-833-6343
  • Fax: 248-833-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL S SHABOU
Title or Position: OWNER
Credential: MD
Phone: 248-833-6343