Healthcare Provider Details

I. General information

NPI: 1053417816
Provider Name (Legal Business Name): G. DANIEL SHANAHAN IV DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9640 COMMERCE RD STE 102
COMMERCE TWP MI
48382-4167
US

IV. Provider business mailing address

9640 COMMERCE RD STE 102
COMMERCE TWP MI
48382-4167
US

V. Phone/Fax

Practice location:
  • Phone: 248-360-3888
  • Fax: 248-363-0894
Mailing address:
  • Phone: 248-360-3888
  • Fax: 248-363-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE DANIEL SHANAHAN IV
Title or Position: OWNER
Credential: DPM
Phone: 248-360-3888