Provider Demographics
NPI:1750309787
Name:SHEVITZ, HENRY A (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:A
Last Name:SHEVITZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24901 NORTHWESTERN HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2205
Mailing Address - Country:US
Mailing Address - Phone:248-357-2100
Mailing Address - Fax:248-357-4272
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:SUITE L103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1330
Practice Address - Country:US
Practice Address - Phone:248-352-9525
Practice Address - Fax:248-357-2959
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-02-22
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Provider Licenses
StateLicense IDTaxonomies
MI4301028752207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIHS028752OtherLICENSE