Provider Demographics
NPI:1275588378
Name:SHULO, MICHAEL FRANCIS (CRNA, MSA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:SHULO
Suffix:
Gender:M
Credentials:CRNA, MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783497
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3497
Mailing Address - Country:US
Mailing Address - Phone:610-395-4044
Mailing Address - Fax:610-395-5693
Practice Address - Street 1:5100 W TILGHMAN ST STE 315
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9166
Practice Address - Country:US
Practice Address - Phone:610-395-4044
Practice Address - Fax:610-395-5693
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN232839L163W00000X, 367500000X
PAAANA#034631174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50077442OtherCAPITAL BLUE CROSS, KEYSTONE CENTRAL, SENIOR BLUE
PA020727GDNMedicare PIN
PA020727Q1RMedicare PIN
PA174777Q1RMedicare PIN
PA0270727Medicare ID - Type Unspecified