Provider Demographics
NPI:1740220052
Name:SHIREMAN, PETER KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KENNETH
Last Name:SHIREMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 NORTON HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4456
Mailing Address - Country:US
Mailing Address - Phone:231-780-3236
Mailing Address - Fax:
Practice Address - Street 1:1774 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2533
Practice Address - Country:US
Practice Address - Phone:231-728-5758
Practice Address - Fax:231-728-5636
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050218207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1543841Medicaid
MI1543841Medicaid