Provider Demographics
NPI:1235134644
Name:MARVIN SHULMAN, MD, PC
Entity Type:Organization
Organization Name:MARVIN SHULMAN, MD, PC
Other - Org Name:THE SENIOR EYE SITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-6600
Mailing Address - Street 1:16530 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1106
Mailing Address - Country:US
Mailing Address - Phone:586-286-6600
Mailing Address - Fax:586-286-3503
Practice Address - Street 1:16530 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1106
Practice Address - Country:US
Practice Address - Phone:586-286-6600
Practice Address - Fax:586-286-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS033963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH0415OtherRAILROAD MEDICARE
MI180E06118OtherBCBS
MI0E06118Medicare PIN
CH0415OtherRAILROAD MEDICARE