Provider Demographics
NPI:1790766962
Name:SHUSTER, MARYLIN RUTH (PA)
Entity Type:Individual
Prefix:
First Name:MARYLIN
Middle Name:RUTH
Last Name:SHUSTER
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Gender:F
Credentials:PA
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Mailing Address - Street 1:25925 TELEGRAPH RD
Mailing Address - Street 2:210
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2518
Mailing Address - Country:US
Mailing Address - Phone:248-746-3218
Mailing Address - Fax:248-849-0369
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:DEPT OF INTERNAL MEDICINE
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3152
Practice Address - Fax:248-849-5378
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI5601003898363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical