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Individual
SHANNON E. MCCORMACK
Active
Individual
SHANNON E. MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101019893
MI
207R00000X
Internal Medicine Physician
64097-21
WI
208M00000X
Hospitalist Physician
Primary
64097-21
WI
390200000X
Student in an Organized Health Care Education/Training Program
5101019893
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100045471
—
WI
Enumeration date
05/18/2012
Last updated
11/21/2016
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