Active NPI
Jack Shartsis, M.D.
- Gastroenterology Physician
- Huntington Woods, MI
National Provider Identifier
1538494372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 4301025592
- Practice address
- 12923 Lincoln Dr
Huntington Woods, MI 48070-1439 - Phone
- (248) 591-7940
- NPI assigned
- Oct 13, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 4301025592 | MI | Primary |
Addresses
Primary practice location
12923 Lincoln Dr
Huntington Woods, MI 48070-1439
Mailing address
12923 Lincoln Dr
Huntington Woods, MI 48070-1439
Phone (248) 591-7940
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301025592 | MI | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255392000000",
"number": "1538494372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12923 LINCOLN DR",
"city": "HUNTINGTON WOODS",
"state": "MI",
"postal_code": "480701439",
"telephone_number": "248-591-7940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12923 LINCOLN DR",
"city": "HUNTINGTON WOODS",
"state": "MI",
"postal_code": "480701439",
"telephone_number": "248-591-7940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHARTSIS",
"first_name": "JACK",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-13",
"last_updated": "2009-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MI",
"license": "4301025592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington Woods, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.