Provider Demographics
NPI:1346296951
Name:SHAVELL, JOEL M (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:M
Last Name:SHAVELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6754 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3064
Mailing Address - Country:US
Mailing Address - Phone:248-855-2450
Mailing Address - Fax:
Practice Address - Street 1:5050 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3249
Practice Address - Country:US
Practice Address - Phone:313-581-2600
Practice Address - Fax:313-581-0228
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006280207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110Q262840OtherBCBSM/BCN
MI5730686OtherAETNA
MI50930OtherOMNICARE HEALTH PLAN
MI236661OtherMEDICARE PROVIDER NO
MI5823027OtherMEDICARE PROVIDER NO.
MI023777OtherMIDWEST HEALTH PLAN
MI114590774Medicaid
MI236661OtherMEDICARE PROVIDER NO
MI0Q26284014Medicare ID - Type Unspecified