Provider Demographics
NPI:1932158326
Name:SHAMAN, PETER P (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:SHAMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:SUITE 313
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2087
Mailing Address - Country:US
Mailing Address - Phone:248-625-8555
Mailing Address - Fax:248-625-3637
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 313
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-625-8555
Practice Address - Fax:248-625-3637
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301061627207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56487Medicare UPIN