Individual
DR. MY LE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14272 N FENTON RD, FENTON, MI 48430-1544
(810) 777-8326
Mailing address
14272 N FENTON RD, FENTON, MI 48430-1544
(810) 777-8326
(810) 777-8327
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
35098937
OH
207W00000X
Ophthalmology Physician
4301092625
MI
207W00000X
Ophthalmology Physician
TP347
KY
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
Primary
4301092625
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000761334
BCBS (ANTHEM)
—
05
—
0065066
—
OH
05
—
201065670
—
IN
05
—
7100204870
—
KY
Enumeration date
02/03/2009
Last updated
03/31/2022
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