Provider Demographics
NPI:1750399655
Name:SHADEL, MARTHA J (DO)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:SHADEL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:888-861-8740
Mailing Address - Fax:866-250-6385
Practice Address - Street 1:7300 CANTON CENTER DR
Practice Address - Street 2:(EMERGENCY DEPT)
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1579
Practice Address - Country:US
Practice Address - Phone:734-454-8002
Practice Address - Fax:734-454-8161
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-06-13
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Provider Licenses
StateLicense IDTaxonomies
MI5101011186207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11288428OtherCAQH