Individual
DR. DALE ROGER SHAMPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(906) 774-1313
Mailing address
1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(906) 774-1313
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301029974
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386409
MOLINA
MI
05
—
1386409
—
MI
05
—
30436700
—
WI
Enumeration date
11/03/2006
Last updated
07/08/2007
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