Provider Demographics
NPI:1548770894
Name:SHUMAKE, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:SHUMAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13130 MERCIER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1222
Mailing Address - Country:US
Mailing Address - Phone:734-301-5821
Mailing Address - Fax:
Practice Address - Street 1:13130 MERCIER ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1222
Practice Address - Country:US
Practice Address - Phone:734-301-5821
Practice Address - Fax:734-301-5821
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2017-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program