Provider Demographics
NPI:1225074271
Name:REISER, SHAWN LESLIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:LESLIE
Last Name:REISER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 S LINDEN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3442
Mailing Address - Country:US
Mailing Address - Phone:215-888-4358
Mailing Address - Fax:810-230-8090
Practice Address - Street 1:1303 S LINDEN RD
Practice Address - Street 2:COMMUNITY PODIATRY GROUP SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3442
Practice Address - Country:US
Practice Address - Phone:215-888-4358
Practice Address - Fax:810-230-8090
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL918367213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4899355Medicaid
MI381898080OtherFEDERAL
MI381898080OtherFEDERAL
MIV10428Medicare UPIN