Provider Demographics
NPI:1013972934
Name:SHUMAKER, BRYAN P (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:P
Last Name:SHUMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BLUE WATER TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-8816
Mailing Address - Country:US
Mailing Address - Phone:248-762-0568
Mailing Address - Fax:
Practice Address - Street 1:289 BLUE WATER TRL
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-8816
Practice Address - Country:US
Practice Address - Phone:248-762-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036561208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA76750OtherHAP
MIA76750OtherHAP