Provider Demographics
NPI:1871676817
Name:SHELTON, CRAIG RICARDO (DPM)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:RICARDO
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DR JOHN C SHELTON BLVD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5412
Mailing Address - Country:US
Mailing Address - Phone:734-487-5007
Mailing Address - Fax:734-487-5259
Practice Address - Street 1:103 DR JOHN C SHELTON BLVD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5412
Practice Address - Country:US
Practice Address - Phone:734-487-5007
Practice Address - Fax:734-487-5259
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001715213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3297390Medicaid
MI480025231OtherMEDICARE RAILROAD
MI4858154280OtherBCBS
MI4858154280OtherBCBS
MI5815428Medicare PIN