Provider Demographics
NPI:1396908539
Name:SHUKAN, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SHUKAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 BYPASS LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8413
Mailing Address - Country:US
Mailing Address - Phone:936-327-2565
Mailing Address - Fax:936-327-2567
Practice Address - Street 1:300 BYPASS LN
Practice Address - Street 2:SUITE 206
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8413
Practice Address - Country:US
Practice Address - Phone:936-327-2565
Practice Address - Fax:936-327-2567
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB26433Medicare UPIN