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General NPI Number Information
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NPI Number | 1003818907
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Entity Type | Individual
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Provider Name | GEORGE DANIEL SHANAHAN IV DPM
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 9640 COMMERCE RD STE 102
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City | COMMERCE TWP
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State | MI
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Zip | 48382-4167
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Country | US
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Telephone | 248-360-3888
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Fax | 248-363-0894
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Provider Business Mailing Address
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Address Line | 9640 COMMERCE RD STE 102
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City | COMMERCE TWP
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State | MI
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Zip | 48382-4167
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Country | US
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Telephone | 248-360-3888
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Fax | 248-363-0894
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | GDS001605
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License Number State | MI
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