Provider Demographics
NPI:1588022099
Name:MCCORD, MICHELE SHAWN
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:SHAWN
Last Name:MCCORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1807
Mailing Address - Country:US
Mailing Address - Phone:810-705-4612
Mailing Address - Fax:
Practice Address - Street 1:108 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1807
Practice Address - Country:US
Practice Address - Phone:810-705-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other