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General NPI Number Information
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NPI Number | 1790721009
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Entity Type | Individual
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Provider Name | MICHELLE ANN SHIELDS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 1975 W M 21
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City | OWOSSO
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State | MI
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Zip | 48867-8163
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Country | US
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Telephone | 989-729-4848
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Fax | 989-729-4849
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Provider Business Mailing Address
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Address Line | 501 LAPEER AVE
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City | SAGINAW
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State | MI
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Zip | 48607-1208
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Country | US
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Telephone | 989-759-6464
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Fax | 989-399-8233
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301066683
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License Number State | MI
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