Provider Demographics
NPI:1194082131
Name:SHELTON, MARIKO KITA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIKO
Middle Name:KITA
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIKO
Other - Middle Name:
Other - Last Name:KITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1750 S TELEGRAPH RD
Mailing Address - Street 2:STE 108
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0166
Mailing Address - Country:US
Mailing Address - Phone:248-334-4505
Mailing Address - Fax:
Practice Address - Street 1:1750 S TELEGRAPH RD
Practice Address - Street 2:STE 108
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0166
Practice Address - Country:US
Practice Address - Phone:248-334-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101128207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology