Provider Demographics
NPI:1891008074
Name:TUTER-SPITZLEY, SHANON M (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANON
Middle Name:M
Last Name:TUTER-SPITZLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHANON
Other - Middle Name:M
Other - Last Name:TUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 776982
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6982
Mailing Address - Country:US
Mailing Address - Phone:800-494-5797
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:FLOOR 4
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1884
Practice Address - Country:US
Practice Address - Phone:231-672-6600
Practice Address - Fax:231-672-4695
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019523207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891008074Medicaid
MO1891008074Medicaid