Provider Demographics
NPI:1881786549
Name:SHAPIRO, MICHAEL SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S ELISEO DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-925-2020
Mailing Address - Fax:415-925-1870
Practice Address - Street 1:1000 S ELISEO DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-925-2020
Practice Address - Fax:415-925-1870
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG52829207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G528290Medicare ID - Type Unspecified