Provider Demographics
NPI:1063646602
Name:MICHAEL L. SHUMAN, M.D.P.A.
Entity Type:Organization
Organization Name:MICHAEL L. SHUMAN, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-774-3835
Mailing Address - Street 1:15 MELLEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2109
Mailing Address - Country:US
Mailing Address - Phone:207-774-3835
Mailing Address - Fax:207-774-2176
Practice Address - Street 1:15 MELLEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2109
Practice Address - Country:US
Practice Address - Phone:207-774-3835
Practice Address - Fax:207-774-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME006809261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB86970Medicare UPIN