Provider Demographics
NPI:1659354256
Name:SHIPKEY, JEFFREY M (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:SHIPKEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-4821
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:420 W MAGNETIC ST
Practice Address - Street 2:SUITE ER
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2711
Practice Address - Country:US
Practice Address - Phone:888-674-0854
Practice Address - Fax:906-225-3370
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015122207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101015122OtherMICHIGAN LICENSE NUMBER
MI4773184Medicaid
MI0M36120014Medicare PIN
MI4773184Medicaid