Provider Demographics
NPI:1154359149
Name:SHAPIRO, ELY (MD)
Entity type:Individual
Prefix:DR
First Name:ELY
Middle Name:
Last Name:SHAPIRO
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 1:501 S DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3234
Mailing Address - Country:US
Mailing Address - Phone:269-343-1296
Mailing Address - Fax:269-344-8485
Practice Address - Street 1:501 S DRAKE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3234
Practice Address - Country:US
Practice Address - Phone:269-343-1296
Practice Address - Fax:269-344-8485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIES430107207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C91567OtherBLUE CARE NETWORK
MI5761707OtherAETNA
MI0C91567OtherBCBS OF MI
MI5466660Medicaid
MIG73126Medicare UPIN
MI5466660Medicaid