Individual
CLAYTON SHAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1711 S STEPHENSON AVE STE 115, IRON MOUNTAIN, MI 49801-3648
(906) 776-5955
(906) 228-0202
Mailing address
PO BOX 549, IRON MOUNTAIN, MI 49801-0549
(906) 774-1313
(906) 776-5639
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125051889
IL
207R00000X
Internal Medicine Physician
4301100058
MI
207RC0000X
Cardiovascular Disease Physician
Primary
4301100058
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0220132
BCBS PIN
MI
Enumeration date
09/05/2008
Last updated
11/17/2020
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