Individual
BRAD A SHAMMOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
36175 HARPER AVE, CLINTON TOWNSHIP, MI 48035-3274
(586) 741-3772
(586) 741-4604
Mailing address
36175 HARPER AVE, CLINTON TOWNSHIP, MI 48035-3274
(586) 741-3772
(586) 741-4604
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101014470
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H26188
BCBS PROVIDER NUMBER
MI
01
—
0Q26008
BCBS PROVIDER NUMBER
MI
05
—
4427962
—
MI
Enumeration date
01/17/2006
Last updated
04/20/2008
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