Provider Demographics
NPI:1750646428
Name:MICHAEL L. SHELLING, MD, LLC
Entity Type:Organization
Organization Name:MICHAEL L. SHELLING, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SHELLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-715-4666
Mailing Address - Street 1:3045 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5347
Mailing Address - Country:US
Mailing Address - Phone:561-715-4666
Mailing Address - Fax:561-998-8403
Practice Address - Street 1:10075 S JOG RD STE 206
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3536
Practice Address - Country:US
Practice Address - Phone:561-737-1100
Practice Address - Fax:561-731-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111217207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty