Provider Demographics
NPI:1568564367
Name:CONNER, SHAWN K (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:K
Last Name:CONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5900 WALDON RD
Mailing Address - Street 2:STE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4806
Mailing Address - Country:US
Mailing Address - Phone:248-625-7890
Mailing Address - Fax:248-625-7527
Practice Address - Street 1:5900 WALDON RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4806
Practice Address - Country:US
Practice Address - Phone:248-625-7890
Practice Address - Fax:248-625-7527
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301059910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4591323Medicaid
MIG18274Medicare UPIN
MIN83650003Medicare PIN