Provider Demographics
NPI:1578769824
Name:FERRELL, MICHAEL SHAY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAY
Last Name:FERRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 E CREEKS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8368
Mailing Address - Country:US
Mailing Address - Phone:812-333-1933
Mailing Address - Fax:812-333-3991
Practice Address - Street 1:1450 ELLIS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8812
Practice Address - Country:US
Practice Address - Phone:406-587-0122
Practice Address - Fax:406-587-5548
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00547207X00000X
MT35120207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917461Medicaid
IN201059840Medicaid
SCNC1367Medicaid
INM400070840Medicare PIN
IN201059840Medicaid
MTM011005288Medicare PIN
NC0397730007Medicare NSC