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NPI Code Detail

MEDICARE: LEIGH KELLY SHOEMAKER M.S., PA-C

MEDICARE: LEIGH KELLY SHOEMAKER M.S., PA-C
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
1363AM0700XMedical Physician Assistant5601005758MI

General Provider Information

NPI Number : 1225349657
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEIGH KELLY SHOEMAKER M.S., PA-C
Provider Business Mailing Address
First Line : 2060 DIVISION AVE S
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-3029
Country : US
Telephone Number : 616-475-8446
Fax Number : 616-475-1272
Provider Business Practice Location Address
First Line : 2060 DIVISION AVE S
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-3029
Country : US
Telephone Number : 616-475-8446
Fax Number : 616-475-1272
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2010
Last Update Date : 05/05/2025

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