Individual
KURT SHEPPARD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
30200 TELEGRAPH RD, SUITE 220, BINGHAM FARMS, MI 48025-4502
(248) 258-5058
Mailing address
1989 ADDALEEN RD, HIGHLAND, MI 48357-3009
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704112180
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104569707
—
MI
Enumeration date
05/01/2006
Last updated
03/16/2017
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