Provider Demographics
NPI:1356454037
Name:SHUCK, MICHAEL W (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:SHUCK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:7348 W 21ST ST N
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1765
Mailing Address - Country:US
Mailing Address - Phone:316-722-0103
Mailing Address - Fax:316-722-2333
Practice Address - Street 1:7348 W 21ST ST N
Practice Address - Street 2:SUITE 121
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1765
Practice Address - Country:US
Practice Address - Phone:316-722-0103
Practice Address - Fax:316-722-2333
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS05-24235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100879Medicare ID - Type Unspecified
KSF36450Medicare UPIN