Provider Demographics
NPI:1275346181
Name:ELLIOTT, MICHAEL SHAWN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11484 NS 367 RD
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-4431
Mailing Address - Country:US
Mailing Address - Phone:405-544-6971
Mailing Address - Fax:
Practice Address - Street 1:11484 NS 367 RD
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-4431
Practice Address - Country:US
Practice Address - Phone:405-544-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist