Provider Demographics
NPI:1134339823
Name:SHOEMAKER, MICHAEL TODD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
Last Name:SHOEMAKER
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 1:11511 PAYNES GRAY
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4645
Mailing Address - Country:US
Mailing Address - Phone:210-695-4284
Mailing Address - Fax:
Practice Address - Street 1:587 BROOK RUN DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3649
Practice Address - Country:US
Practice Address - Phone:210-872-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN87252080N0001X
OH35-1229892080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine