Provider Demographics
NPI:1881637957
Name:SHAPIRO, LARRY (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6698 TORYBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2161
Mailing Address - Country:US
Mailing Address - Phone:248-683-9280
Mailing Address - Fax:
Practice Address - Street 1:6698 TORYBROOKE CIR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2161
Practice Address - Country:US
Practice Address - Phone:248-683-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9795208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H231320OtherBCBSM GROUP
MI1881637957Medicaid
FL277776200Medicaid
MI0P54860001Medicare PIN
MI0H231320OtherBCBSM GROUP