Provider Demographics
NPI:1295705812
Name:SHUSTER, THOMAS A (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:600 HEALTH PARK BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2558
Mailing Address - Country:US
Mailing Address - Phone:810-606-1660
Mailing Address - Fax:810-606-1655
Practice Address - Street 1:600 HEALTH PARK BLVD
Practice Address - Street 2:STE G
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2558
Practice Address - Country:US
Practice Address - Phone:810-606-1660
Practice Address - Fax:810-606-1655
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MITS0136692086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI143615OtherGREAT LAKES HLTH PLAN
MI136403OtherPREFERRED CHOICE PPO
MIP00002373OtherRAILROAD MEDICARE
MI382237803053OtherCOMMUNITY CHOICE
MI1008146OtherMCLAREN HLTH PLAN/ADVANTA
MI136403OtherCARE CHOICE HMO
MI0995443OtherHEALTHPLUS OF MICHIGAN
MI0252512045OtherBC/BS OF MICHIGAN
MI114495800Medicaid
MI7013451OtherAETNA
MIH80577OtherHEALTH ALLIANCE PLAN
MIH80577Medicare UPIN