Individual
SHANNON E. MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1969 W HART RD, BELOIT MEMORIAL HOSPITAL, BELOIT, WI 53511-2230
(608) 363-5971
(608) 363-5737
Mailing address
1905 E HUEBBE PKWY, BELOIT HEALTH SYSTEM INC, BELOIT, WI 53511-1842
(608) 364-2200
(608) 363-7395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101019893
MI
207R00000X
Internal Medicine Physician
64097-21
WI
208M00000X
Hospitalist Physician
Primary
64097-21
WI
390200000X
Student in an Organized Health Care Education/Training Program
5101019893
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100045471
—
WI
Enumeration date
05/18/2012
Last updated
11/21/2016
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