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NPI Code Detail

MEDICARE: DR. MICHAEL CAROLL SHANNON MD

MEDICARE: DR. MICHAEL CAROLL SHANNON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080P0203XPediatric Critical Care Medicine PhysicianMD60096471WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164531497
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL CAROLL SHANNON MD
Provider Business Mailing Address
First Line : 1101 MADISON ST STE 800
Second Line : SWEDISH PEDIATRIC SPECIALTY CARE
City : SEATTLE
State : WA
Zip : 98104-1307
Country : US
Telephone Number : 206-215-2700
Fax Number : 206-215-2702
Provider Business Practice Location Address
First Line : 1101 MADISON ST STE 800
Second Line : SWEDISH PEDIATRIC SPECIALTY CARE
City : SEATTLE
State : WA
Zip : 98104-1307
Country : US
Telephone Number : 206-215-2700
Fax Number : 206-215-2702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 08/26/2013

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Directions to “ DR. MICHAEL CAROLL SHANNON MD” Practice Location

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