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General NPI Number Information
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NPI Number | 1902889868
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Entity Type | Individual
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Provider Name | MARCIA SHATTUCK MD
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Gender | Female
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 416 CONNABLE AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-2212
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Country | US
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Telephone | 213-487-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 8857 RELIABLE PARKAWAY
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City | CHICAGO
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State | IL
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Zip | 60686-0001
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Country | US
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Telephone |
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 4301061137
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License Number State | MI
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