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1770562332

NPI Code Detail

MEDICARE: MR. DOUGLAS R. SHEARER MD

MEDICARE: MR. DOUGLAS R. SHEARER 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	208D00000X	General Practice Physician	49875-20	WI
2	207W00000X	Ophthalmology Physician	055770	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1770562332	OTHER	MI	MEDICARE INDIVIDUAL PTAN
4	1356594691	OTHER	MI	MEDICARE GR UPIN
6	MI1247	OTHER	MI	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MI1247001	OTHER	MI	INDIVIDUAL PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770562332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS R. SHEARER MD

Provider Business Mailing Address
First Line	:	N204 POTTAWATOMI TRL
Second Line	:
City	:	MILTON
State	:	WI
Zip	:	53563-9501
Country	:	US
Telephone Number	:	906-458-0198
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 22ND AVE
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-1569
Country	:	US
Telephone Number	:	608-324-2000
Fax Number	:	608-324-1246

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	03/24/2021

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Directions to “ MR. DOUGLAS R. SHEARER MD” Practice Location

Language	Start Address	Practice Location

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