Provider Demographics
NPI:1780675579
Name:SHELLHOUSE, JULIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:SHELLHOUSE
Suffix:
Gender:F
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:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-727-5211
Mailing Address - Fax:231-727-4571
Practice Address - Street 1:71 BEVIER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455
Practice Address - Country:US
Practice Address - Phone:231-861-2187
Practice Address - Fax:231-861-5100
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4556511Medicaid
MI79630005Medicare ID - Type Unspecified
MI4556511Medicaid