Provider Demographics
NPI:1336389352
Name:SHORUNKE, MICHAEL (LVN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SHORUNKE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 MONTEGO DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4007
Mailing Address - Country:US
Mailing Address - Phone:817-323-9981
Mailing Address - Fax:817-470-4162
Practice Address - Street 1:2306 MONTEGO DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4007
Practice Address - Country:US
Practice Address - Phone:817-323-9981
Practice Address - Fax:817-470-4162
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health