Provider Demographics
NPI:1730179946
Name:SHUSTER, JEFFREY M (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42633 GARFIELD RD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5033
Mailing Address - Country:US
Mailing Address - Phone:586-263-0777
Mailing Address - Fax:586-263-5457
Practice Address - Street 1:42633 GARFIELD RD
Practice Address - Street 2:SUITE 319
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5033
Practice Address - Country:US
Practice Address - Phone:586-263-0777
Practice Address - Fax:586-263-5457
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043096207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI157883Medicaid
A74502Medicare UPIN
MI157883Medicaid