Healthcare Provider Details

I. General information

NPI: 1184845331
Provider Name (Legal Business Name): SPIRO AND SHANBOM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28747 WOODWARD AVE
BERKLEY MI
48072-0914
US

IV. Provider business mailing address

28747 WOODWARD AVE
BERKLEY MI
48072-0914
US

V. Phone/Fax

Practice location:
  • Phone: 248-546-2133
  • Fax: 248-546-6036
Mailing address:
  • Phone: 248-546-2133
  • Fax: 248-546-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301054486
License Number StateMI

VIII. Authorized Official

Name: DR. STEVEN ADAM SHANBOM
Title or Position: PRESIDENT
Credential: MD
Phone: 248-546-2133