Provider Demographics
NPI:1902049307
Name:SHIELDS, MARGARET L (DPM)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 WESTWICK PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1405
Mailing Address - Country:US
Mailing Address - Phone:314-270-9203
Mailing Address - Fax:
Practice Address - Street 1:12152 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1779
Practice Address - Country:US
Practice Address - Phone:314-892-1442
Practice Address - Fax:314-892-4523
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022634213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery