Individual
THOMAS R SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, MC 109 ATTN JULIE L, GRAND RAPIDS, MI 49503-2560
(616) 391-1714
Mailing address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
4301044306
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558407189
GROUP NPI
MI
05
—
1677700
—
MI
01
—
3504126341
BCBS
MI
Enumeration date
02/21/2006
Last updated
07/28/2008
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