MEDICARE: DR. SCOTT PAUL SHISLER 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	5101014000	MI
2	207R00000X	Internal Medicine Physician	5101014000	MI
3	208M00000X	Hospitalist Physician	5101014000	MI

General Provider Information

NPI Number	:	1477551000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT PAUL SHISLER D.O.

Provider Business Mailing Address
First Line	:	1100 S VAN DYKE
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413
Country	:	US
Telephone Number	:	989-269-9521
Fax Number	:	989-269-1562

Provider Business Practice Location Address
First Line	:	1100 S VAN DYKE
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413
Country	:	US
Telephone Number	:	989-269-9521
Fax Number	:	989-269-8908

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	03/28/2016

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