Provider Demographics
NPI:1003858770
Name:SHAY, ERIC S (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:SHAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-170
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-381-5060
Mailing Address - Fax:269-381-1655
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-170
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-5060
Practice Address - Fax:269-381-1655
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301059651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110C910470OtherBCBS GRP PIN
155422OtherGREAT LAKES HLTH PLN
MI3489263-10Medicaid
5033427OtherAETNA PIN
MI1103902331OtherBCBS IND PIN
MI1003858770Medicaid
383148262OtherEIN-HEALTHCARE MIDWEST
MI3489263-10Medicaid
383148262OtherEIN-HEALTHCARE MIDWEST
155422OtherGREAT LAKES HLTH PLN
MIC97618249Medicare PIN
MI0C97625033Medicare ID - Type Unspecified