Provider Demographics
NPI:1144316340
Name:SHELLNUT, JASON KIMBALL (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:KIMBALL
Last Name:SHELLNUT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1121 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1301
Mailing Address - Country:US
Mailing Address - Phone:248-541-8554
Mailing Address - Fax:248-541-1791
Practice Address - Street 1:1121 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1301
Practice Address - Country:US
Practice Address - Phone:248-541-8554
Practice Address - Fax:248-541-1791
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2017-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAR-6999208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery