Provider Demographics
NPI:1083803993
Name:SHADIGIAN, ELIZABETH MARY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:SHADIGIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2340 E STADIUM BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4823
Mailing Address - Country:US
Mailing Address - Phone:734-477-5100
Mailing Address - Fax:734-477-5111
Practice Address - Street 1:2340 E STADIUM BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4823
Practice Address - Country:US
Practice Address - Phone:734-477-5100
Practice Address - Fax:734-477-5111
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064081207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3139819Medicaid
MI4414900Medicaid