Provider Demographics
NPI:1629311840
Name:SHUKHMAN, MICHELLE SUSAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SUSAN
Last Name:SHUKHMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:SUSAN
Other - Last Name:GRUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE #320
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-774-3838
Mailing Address - Fax:818-774-3839
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE #320
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-774-3838
Practice Address - Fax:818-774-3839
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13754207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program