Provider Demographics
NPI:1568485233
Name:SHRAMOWIAT, MICHAEL (LLC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SHRAMOWIAT
Suffix:
Gender:M
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 46TH ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-9409
Mailing Address - Country:US
Mailing Address - Phone:304-295-3131
Mailing Address - Fax:304-295-0700
Practice Address - Street 1:1158 46TH ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-9409
Practice Address - Country:US
Practice Address - Phone:304-295-3131
Practice Address - Fax:304-295-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17187208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0113659000Medicaid
WVE92532Medicare UPIN
WV0791121Medicare PIN