Individual
MICHAEL RICHARD SHAMPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
2135 PIERCE AVE, MARINETTE, WI 54143-3947
(715) 735-1300
Mailing address
702 MICHAELIS ST, MARINETTE, WI 54143-1041
(906) 748-4603
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1107-39
WI
Other
Enumeration date
08/08/2024
Last updated
08/08/2024
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