Provider Demographics
NPI:1053430686
Name:SHELDEN, MICHAEL A (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SHELDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5200
Mailing Address - Country:US
Mailing Address - Phone:269-387-3290
Mailing Address - Fax:269-387-2944
Practice Address - Street 1:1903 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5200
Practice Address - Country:US
Practice Address - Phone:269-387-3290
Practice Address - Fax:269-387-2944
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010083332083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700C943750OtherBLUE CROSS GROUP PIN
MI1153911694OtherBLUE CROSS INDIVIDUAL PIN
0P46120OtherGROUP PTAN
MI700C943750OtherBLUE CROSS GROUP PIN
0P46120OtherGROUP PTAN
MI0M22440028Medicare PIN