Individual
DR. JOHN MICHAEL SHUTACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 MEDICAL PKWY STE 206, CHESAPEAKE, VA 23320
(757) 690-8990
(757) 198-6944
Mailing address
667 KINGSBOROUGH SQ STE 101, CHESAPEAKE, VA 23320-4999
(757) 842-4481
(757) 312-3135
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
0101102740
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101102740
MEDICAL LICENSE
VA
Enumeration date
09/26/2006
Last updated
06/20/2024
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