Provider Demographics
NPI:1730779794
Name:PINCHEM, SHANTEL
Entity type:Individual
Prefix:MS
First Name:SHANTEL
Middle Name:
Last Name:PINCHEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33717 WOODWARD AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0913
Mailing Address - Country:US
Mailing Address - Phone:248-247-1137
Mailing Address - Fax:
Practice Address - Street 1:41140 GARFIELD RD STE 206
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1903
Practice Address - Country:US
Practice Address - Phone:248-247-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty