Provider Demographics
NPI:1366450983
Name:SHAPIRO, JOAN HALTMAN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:HALTMAN
Last Name:SHAPIRO
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 1:24333 ORCHARD LAKE RD
Mailing Address - Street 2:STE G
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336
Mailing Address - Country:US
Mailing Address - Phone:248-471-7880
Mailing Address - Fax:248-471-2017
Practice Address - Street 1:24333 ORCHARD LAKE RD
Practice Address - Street 2:STE G
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-471-7880
Practice Address - Fax:248-471-2017
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS033979207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B46246Medicare UPIN
0639177Medicare ID - Type Unspecified