Individual
MARTHA J SHADEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7300 CANTON CENTER DR, (EMERGENCY DEPT), CANTON, MI 48187-1579
(734) 454-8002
(734) 454-8161
Mailing address
38935 ANN ARBOR RD, CREDENTIALING DEPARTMENT, LIVONIA, MI 48150-3397
(888) 861-8740
(866) 250-6385
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101011186
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11288428
CAQH
—
Enumeration date
08/04/2006
Last updated
06/13/2013
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