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General NPI Number Information
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NPI Number | 1417032491
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Entity Type | Individual
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Provider Name | BERNARD W. SHELTON MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 30140 HARPER AVE SUITE 300
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1610
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Country | US
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Telephone | 586-293-1868
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Fax | 586-293-1869
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Provider Business Mailing Address
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Address Line | 30140 HARPER AVE SUITE 300
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1610
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Country | US
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Telephone | 586-293-1868
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Fax | 586-293-1869
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301088798
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 4301088798
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License Number State | MI
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