Provider Demographics
NPI:1669683462
Name:HALL, SHAWN M (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:M
Last Name:HALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PEELER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2300
Mailing Address - Country:US
Mailing Address - Phone:269-345-8618
Mailing Address - Fax:269-345-1508
Practice Address - Street 1:900 PEELER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2300
Practice Address - Country:US
Practice Address - Phone:269-345-8618
Practice Address - Fax:269-345-1508
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008340207L00000X
MI5101015562207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2771022Medicaid
OH000000225048OtherUNISON
OH000000533057OtherANTHEM
OH0583328OtherBCMH
OH751149OtherBUCKEYE MEDICAID
OH417902OtherWELLCARE MEDICAID
OH9671066OtherAETNA
OH417902OtherWELLCARE MEDICAID