Provider Demographics
NPI:1255519518
Name:SHETLAR, JAMES FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANCIS
Last Name:SHETLAR
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 1:163 F CHURCHGROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-9322
Mailing Address - Country:US
Mailing Address - Phone:989-652-9969
Mailing Address - Fax:
Practice Address - Street 1:163 F CHURCHGROVE ROAD
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-9322
Practice Address - Country:US
Practice Address - Phone:989-652-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS30247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJS30247OtherLICENSE
B44846Medicare PIN
MIJS30247OtherLICENSE