Provider Demographics
NPI:1568511871
Name:JAMES F SHETLAR MD PC
Entity Type:Organization
Organization Name:JAMES F SHETLAR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHETLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-652-9969
Mailing Address - Street 1:163 F CHURCH GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-9322
Mailing Address - Country:US
Mailing Address - Phone:989-652-9969
Mailing Address - Fax:
Practice Address - Street 1:163 F CHURCH GROVE ROAD
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-9322
Practice Address - Country:US
Practice Address - Phone:989-652-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS30247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILICENSEJS30247OtherLICENSE
4732168Medicare ID - Type Unspecified
MILICENSEJS30247OtherLICENSE