Provider Demographics
NPI:1356380802
Name:SHEPHERD, DAVID MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTIN
Last Name:SHEPHERD
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 1:30178 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2156
Mailing Address - Country:US
Mailing Address - Phone:248-661-9068
Mailing Address - Fax:
Practice Address - Street 1:41935 W 12 MILE RD
Practice Address - Street 2:103
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3111
Practice Address - Country:US
Practice Address - Phone:248-347-8030
Practice Address - Fax:248-305-6694
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI32402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00288647OtherMEDICARE RAILROAD
MIP00288647OtherMEDICARE RAILROAD
MI27670001Medicare PIN