Individual provider Active NPI

Michael A Shelden, DO

  • Occupational Medicine Physician
  • Kalamazoo, MI
National Provider Identifier
1053430686
Registry record updated Dec 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
License
5101008333 Issued in MI
Practice address
1903 W Michigan Ave
Kalamazoo, MI 49008-5200
Phone
(269) 387-3290
Fax
(269) 387-2944
NPI assigned
Mar 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Physician 2083X0100X 5101008333 MI Primary

Addresses

Primary practice location

1903 W Michigan Ave
Kalamazoo, MI 49008-5200

Mailing address

1903 W Michigan Ave
Kalamazoo, MI 49008-5200
Phone (269) 387-3290

Other identifiers 3

IdentifierTypeStateIssuer
700C943750OtherMIBLUE CROSS GROUP PIN
1153911694OtherMIBLUE CROSS INDIVIDUAL PIN
0P46120OtherGROUP PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101008333MIMDOccupational Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228780800000",
    "number": "1053430686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 W MICHIGAN AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490085200",
            "telephone_number": "269-387-3290",
            "fax_number": "269-387-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 W MICHIGAN AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490085200",
            "telephone_number": "269-387-3290",
            "fax_number": "269-387-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELDEN",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2008-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "MI",
            "license": "5101008333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP PIN",
            "identifier": "700C943750",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS INDIVIDUAL PIN",
            "identifier": "1153911694",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "0P46120",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.