Provider Demographics
NPI:1861439515
Name:SHIFFLETT, MICHAEL WADE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WADE
Last Name:SHIFFLETT
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 1:3273 CLAREMONT WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3306
Mailing Address - Country:US
Mailing Address - Phone:707-254-7117
Mailing Address - Fax:707-265-6435
Practice Address - Street 1:3273 CLAREMONT WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2908
Practice Address - Country:US
Practice Address - Phone:707-254-7117
Practice Address - Fax:707-265-6435
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43050207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43050OtherMEDICAL LICENSE
CA00G43050Medicare PIN
AS1490313Medicare UPIN
CAG43050OtherMEDICAL LICENSE