Healthcare Provider Details

I. General information

NPI: 1699766634
Provider Name (Legal Business Name): PAUL SHAPIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR SUITE R2009
YPSILANTI MI
48197-1014
US

IV. Provider business mailing address

5333 MCAULEY DR SUITE R2009
YPSILANTI MI
48197-1014
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-0050
  • Fax: 734-712-0055
Mailing address:
  • Phone: 734-712-0050
  • Fax: 734-712-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPS043484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: