Basic Information
| Provider Information | |||||||||
| NPI: | 1619177185 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAPIRO | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 2ND AVE S | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554023318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126597111 | ||||||||
| FaxNumber: | 6126597101 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 2ND AVE S | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554023318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126597111 | ||||||||
| FaxNumber: | 6126597101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 02/07/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SF0001X | TP005733B | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health |
No ID Information.