HEALTH SPECIALISTS OF LENAWEE P C

Provider Demographics

• NPI: 1922185305
• Name: HEALTH SPECIALISTS OF LENAWEE P C
• Entity Type: Organization
• Organization Name: HEALTH SPECIALISTS OF LENAWEE P C
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: DENNIS
• Authorized Official - Middle Name: NORBERT
• Authorized Official - Last Name: SHELLE
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 517-423-6803
• Mailing Address - Street 1: PO BOX 130
• Mailing Address - City: TECUMSEH
• Mailing Address - State: MI
• Mailing Address - Zip Code: 49286-0130
• Mailing Address - Country: US
• Mailing Address - Phone: 517-423-6803
• Mailing Address - Fax: 517-423-7257
• Practice Address - Street 1: 6869 OCCIDENTAL HIGHWAY
• Practice Address - City: TECUMSEH
• Practice Address - State: MI
• Practice Address - Zip Code: 49286-0130
• Practice Address - Country: US
• Practice Address - Phone: 517-423-6803
• Practice Address - Fax: 517-423-7257
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-01
• Last Update Date: 2009-05-29

Provider Licenses

State	License ID	Taxonomies
MI	DS047781	174400000X
MI	AB403854	174400000X
MI	BC082902	174400000X
MI	LB008900	174400000X
MI	WR082938	174400000X
MI	AB074281	174400000X
MI	LF075422	174400000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	174400000X	Other Service Providers	Specialist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	2768873	Medicaid
MI	4165036	Medicaid
MI	3455247	Medicaid
MI	4573577	Medicaid
MI	4597443	Medicaid
MI	4711421	Medicaid
MI	4634313	Medicaid
MI	4711421	Medicaid
MI	B48588	Medicare UPIN
MI	0N95070002	Medicare ID - Type Unspecified
MI	3455247	Medicaid
MI	A78317	Medicare UPIN
MI	E33197	Medicare UPIN
MI	H62545	Medicare UPIN
MI	0N95070001	Medicare ID - Type Unspecified
MI	4634313	Medicaid