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General NPI Number Information
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NPI Number | 1245429281
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Entity Type | Organization
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Legal Business Name | GARY H. SHAW, M.D., P.C.
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 560 W MITCHELL ST STE 505
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City | PETOSKEY
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State | MI
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Zip | 49770-2275
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Country | US
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Telephone | 231-487-2100
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Fax | 231-487-6049
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Provider Business Mailing Address
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Address Line | 560 W MITCHELL ST STE 505
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City | PETOSKEY
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State | MI
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Zip | 49770-2275
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Country | US
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Telephone | 231-487-2100
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Fax | 231-487-6049
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY H. SHAW
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Credential | M.D.
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Telephone | 231-487-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 4301045389
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License Number State | MI
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