Provider Demographics
NPI:1871685677
Name:BEZAK, SHAUN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:MICHAEL
Last Name:BEZAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 HANOVER PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2011
Mailing Address - Country:US
Mailing Address - Phone:301-220-0496
Mailing Address - Fax:301-220-2303
Practice Address - Street 1:7500 HANOVER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2011
Practice Address - Country:US
Practice Address - Phone:301-220-0496
Practice Address - Fax:301-220-2303
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO2141225100000X
MDS02141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1039615OtherASHN/CIGNA
MD61837201OtherBLUE CROSS BLUE SHIELD MD
MD7879466OtherAETNA/PROVIDER NON HMO
MDG7520001OtherBLUE CROSS BLUE SHIELD DC
MD2319509OtherUNITED HEALTHCARE
MD2096855OtherFIRST HEALTH/MAILHANDLERS
MD2120465OtherMAMSI/MDIPA/OPT./ALLIANCE
MD652647OtherACN
MD3137927OtherAETNA PROVIDER HMO
MD2096855OtherFIRST HEALTH/MAILHANDLERS