Provider Demographics
NPI:1659559870
Name:CRAIG R. SHELTON, DPM
Entity Type:Organization
Organization Name:CRAIG R. SHELTON, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-487-5007
Mailing Address - Street 1:103 FERRIS ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5412
Mailing Address - Country:US
Mailing Address - Phone:734-487-5007
Mailing Address - Fax:734-487-5259
Practice Address - Street 1:103 FERRIS ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5412
Practice Address - Country:US
Practice Address - Phone:734-487-5007
Practice Address - Fax:734-487-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001715213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4832600001Medicare NSC