Provider Demographics
NPI:1518095074
Name:SHEBUSKI, MARILEE GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILEE
Middle Name:GAIL
Last Name:SHEBUSKI
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 1:540 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-2031
Mailing Address - Country:US
Mailing Address - Phone:906-482-7382
Mailing Address - Fax:906-482-9410
Practice Address - Street 1:540 DEPOT ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-2031
Practice Address - Country:US
Practice Address - Phone:906-482-7382
Practice Address - Fax:906-482-9410
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4310039985208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB45962Medicare UPIN
MI0-C1-10012-992Medicare PIN