MEDICARE: DR. MICHAEL B SHAW D.O.

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	207Y00000X	Otolaryngology Physician	1907	OK

General Provider Information

NPI Number	:	1134109358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL B SHAW D.O.

Provider Business Mailing Address
First Line	:	4230 W 83RD ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-3020
Country	:	US
Telephone Number	:	918-446-2181
Fax Number	:

Provider Business Practice Location Address
First Line	:	4230 W 83RD ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-3020
Country	:	US
Telephone Number	:	918-446-2181
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	01/04/2012

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