MEDICARE: BRYAN P SHUMAKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	4301036561	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A76750	OTHER	MI	HAP

General Provider Information

NPI Number	:	1013972934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN P SHUMAKER MD

Provider Business Mailing Address
First Line	:	289 BLUE WATER TRL
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712-8816
Country	:	US
Telephone Number	:	248-762-0568
Fax Number	:

Provider Business Practice Location Address
First Line	:	289 BLUE WATER TRL
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712-8816
Country	:	US
Telephone Number	:	248-762-0568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/05/2011

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