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General NPI Number Information
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NPI Number | 1619241783
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Entity Type | Individual
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Provider Name | MICHAEL JAMES ELKINS SHANKS DO
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Gender | Male
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 3401 S 4TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802
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Country | US
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Telephone | 812-232-9596
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Fax | 812-232-7992
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Provider Business Mailing Address
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Address Line | 3401 S 4TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-5501
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Country | US
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Telephone | 812-201-3807
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Fax |
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 02005486A
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License Number State | IN
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