Provider Demographics
NPI:1881751261
Name:SHEN, VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:SHEN
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:PO BOX 913
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-0913
Mailing Address - Country:US
Mailing Address - Phone:269-789-3940
Mailing Address - Fax:269-789-3879
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-789-3940
Practice Address - Fax:269-789-3879
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT104098207RH0003X, 207RX0202X
VA0101039774207RH0003X
IN01090612A207RH0003X
MI4301082993207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI760748463OtherTAX ID
MI104594094Medicaid
MI1101310581OtherBCBS MICHIGAN PROVIDER
MI1101310581OtherBCBS MICHIGAN PROVIDER
MI760748463OtherTAX ID
MIB09955Medicare UPIN