Individual
GARY H SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
416 CONNABLE AVE, PETOSKEY, MI 49770-2212
(231) 487-7303
(231) 487-7313
Mailing address
560 W MITCHELL ST, STE 160, PETOSKEY, MI 49770-2276
(231) 487-3295
(231) 487-5069
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4301045389
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013921154
—
MI
01
—
GS045389
BS STATE LIC#
MI
Enumeration date
07/27/2006
Last updated
09/25/2020
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