Provider Demographics
NPI:1376547810
Name:SHULMAN, MARVIN (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:SHULMAN
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16530 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1106
Mailing Address - Country:US
Mailing Address - Phone:586-286-6600
Mailing Address - Fax:586-286-3503
Practice Address - Street 1:16530 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1106
Practice Address - Country:US
Practice Address - Phone:586-286-6600
Practice Address - Fax:586-286-3503
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS 033963207W00000X
MIMS033963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
180500207OtherBCBS OF MI
MICH0415OtherRAILROAD MEDICARE
A77010Medicare UPIN
MICH0415OtherRAILROAD MEDICARE
0500207Medicare ID - Type Unspecified