Provider Demographics
NPI:1164466223
Name:SHINGLES, MICHAEL BRADLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:SHINGLES
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD # A201
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:SUITE 420
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5376
Practice Address - Country:US
Practice Address - Phone:517-884-6100
Practice Address - Fax:517-884-6233
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012993207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1164466223Medicaid
MI4322272Medicaid
MI4322272Medicaid
MIH51261Medicare UPIN