Individual
MICHAEL YUZHOU SHAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1818 CAREW ST STE 230, FORT WAYNE, IN 46805-4764
(260) 266-4640
(260) 266-4638
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036117153
IL
2086S0129X
Vascular Surgery Physician
Primary
01092661A
IN
2086S0129X
Vascular Surgery Physician
036117153
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117153
—
IL
01
—
406120
MEDICARE PTAN FOR SCMG
IL
01
—
406120075
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
01/04/2010
Last updated
03/03/2025
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