Shannon Rae Dufek, PA-C
Individual provider Active NPI Physician Assistant · Lanse, MI
NPI 1114598638 · NPPES record last updated Jul 6, 2021
Key facts
- NPI
- 1114598638
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601010681 (MI)
- Practice address
- 18341 US Highway 41
Lanse, MI 49946-8024 - Phone
- (906) 525-3300
- NPI assigned
- Jul 6, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230130000439 | MI | Practitioner - Physician Assistant | 1456722461 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601010681 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baraga County Memorial Hospital | Multi-Specialty | Current |
Accepting new patients |
| Baraga County Memorial Hospital | Current |
Accepting new patients | |
| Baraga County Memorial Hospital | Multi-Specialty | Current | Accepting new patients |
Locations
18341 US Highway 41
Lanse, MI 49946
Phone (906) 524-3300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant |
363A00000X | 5601010681 | MI | Yes |
Addresses
Primary practice location
18341 US Highway 41
Lanse, MI 49946-8024
Mailing address
119 Michigan Ave
Baraga, MI 49908-9676
Phone (906) 201-2499
Other names
- Ms. Shannon Rae Fish
Other providers in Lanse, MI
- Courtney Ann Darcy
- Jeffrey S Dauphinais
- Pam Dove
- Ronda Dowd
- Elaine Dawn Dube
- Rita Erickson
- Angela Marie Gray
- Great Lakes Recovery Centers
- Great Lakes Recovery Centers
- Renee Hahn
All providers in Lanse, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.