Provider Demographics
NPI:1528152808
Name:MARVIN SHULMAN MD PC
Entity type:Organization
Organization Name:MARVIN SHULMAN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-286-5880
Mailing Address - Street 1:16530 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-286-5880
Mailing Address - Fax:586-412-5027
Practice Address - Street 1:16530 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-286-5880
Practice Address - Fax:586-412-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS033963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH0415OtherRAILROAD MEDICARE
540E006980OtherBCBS OF MI
MI1193460001Medicare NSC
CH0415Medicare PIN