Provider Demographics
NPI:1467690131
Name:SHAW, MY LE (MD)
Entity Type:Individual
Prefix:DR
First Name:MY LE
Middle Name:
Last Name:SHAW
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 1:14272 N FENTON RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1544
Mailing Address - Country:US
Mailing Address - Phone:810-777-8326
Mailing Address - Fax:810-777-8327
Practice Address - Street 1:14272 N FENTON RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1544
Practice Address - Country:US
Practice Address - Phone:810-777-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092625207W00000X, 207WX0009X
OH35098937207W00000X
KYTP347207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065066Medicaid
KY7100204870Medicaid
000000761334OtherBCBS (ANTHEM)
IN201065670Medicaid
KY7100204870Medicaid
OH0065066Medicaid