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General NPI Number Information
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NPI Number | 1871676817
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Entity Type | Individual
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Provider Name | CRAIG RICARDO SHELTON DPM
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 103 DR JOHN C SHELTON BLVD
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City | YPSILANTI
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State | MI
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Zip | 48197-5412
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Country | US
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Telephone | 734-487-5007
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Fax | 734-487-5259
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Provider Business Mailing Address
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Address Line | 103 DR JOHN C SHELTON BLVD
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City | YPSILANTI
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State | MI
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Zip | 48197-5412
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Country | US
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Telephone | 734-487-5007
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Fax | 734-487-5259
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001715
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License Number State | MI
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