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NPI Code Detail

MEDICARE: DR. MICHAEL B. SHROCK D.O.

MEDICARE: DR. MICHAEL B. SHROCK 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
1207Q00000XFamily Medicine Physician11315MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080105518OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578545968
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL B. SHROCK D.O.
Provider Business Mailing Address
First Line : 965 RIDGE LAKE BLVD STE 315
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-9401
Country : US
Telephone Number : 877-348-1281
Fax Number : 901-227-3206
Provider Business Practice Location Address
First Line : 1056 HOLLAND AVE
Second Line :
City : PHILADELPHIA
State : MS
Zip : 39350-9121
Country : US
Telephone Number : 601-656-8545
Fax Number : 601-656-3985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2005
Last Update Date : 12/30/2024

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