Provider Demographics
NPI:1205892981
Name:SHAPIRO, EVAN RONALD (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:RONALD
Last Name:SHAPIRO
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 1:2480 WEST CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-772-1609
Mailing Address - Fax:989-953-4949
Practice Address - Street 1:2480 WEST CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-1609
Practice Address - Fax:989-953-4949
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076680208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDD1273OtherMEDICARE RAILROAD GROUP
MI1487796504Medicaid
MI1174698336Medicaid
MI0N95180Medicare PIN
MIDD1273OtherMEDICARE RAILROAD GROUP