Provider Demographics
NPI:1366499055
Name:SHORTSLEEVE, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SHORTSLEEVE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 382328
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-2328
Mailing Address - Country:US
Mailing Address - Phone:617-661-1949
Mailing Address - Fax:617-661-1943
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-499-5070
Practice Address - Fax:617-499-5138
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA364812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology