Provider Demographics
NPI:1912971474
Name:SHUMAN, MICHAEL LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEWIS
Last Name:SHUMAN
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 1:15 MELLEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2109
Mailing Address - Country:US
Mailing Address - Phone:207-774-3835
Mailing Address - Fax:207-774-2176
Practice Address - Street 1:15 MELLEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2109
Practice Address - Country:US
Practice Address - Phone:207-774-3835
Practice Address - Fax:207-774-2176
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME 006809207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111200000Medicaid
ME111200000Medicaid
ME123978Medicare ID - Type UnspecifiedMEDICARE NUMBER