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General NPI Number Information
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NPI Number | 1164531497
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Entity Type | Individual
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Provider Name | MICHAEL CAROLL SHANNON MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 1101 MADISON ST STE 800 SWEDISH PEDIATRIC SPECIALTY CARE
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City | SEATTLE
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State | WA
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Zip | 98104-1307
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Country | US
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Telephone | 206-215-2700
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Fax | 206-215-2702
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Provider Business Mailing Address
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Address Line | 1101 MADISON ST STE 800 SWEDISH PEDIATRIC SPECIALTY CARE
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City | SEATTLE
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State | WA
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Zip | 98104-1307
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Country | US
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Telephone | 206-215-2700
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Fax | 206-215-2702
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | MD60096471
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License Number State | WA
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