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General NPI Number Information
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NPI Number | 1720056336
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Entity Type | Individual
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Provider Name | MICHAEL F SHANK DO
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 4190 E WOODMEN RD STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-8075
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Country | US
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Telephone | 719-632-4455
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Fax | 719-633-4613
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Provider Business Mailing Address
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Address Line | 5020 N NEVADA AVE BLDG K
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-8609
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Country | US
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Telephone | 206-395-7870
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS-004716-L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0061679
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License Number State | CO
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