Provider Demographics
NPI:1235354804
Name:SHOEMAKER, AMANDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:L
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 N. AURELIUS RD
Mailing Address - Street 2:STE 22
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1594
Mailing Address - Country:US
Mailing Address - Phone:517-694-2217
Mailing Address - Fax:
Practice Address - Street 1:2040 N. AURELIUS RD
Practice Address - Street 2:STE 22
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1594
Practice Address - Country:US
Practice Address - Phone:517-694-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine