MEDICARE: SPIRO AND SHANBOM MD PC

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
1	174400000X	Specialist	4301054486	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA2010	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1184845331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRO AND SHANBOM MD PC

Provider Business Mailing Address
First Line	:	28747 WOODWARD AVE
Second Line	:
City	:	BERKLEY
State	:	MI
Zip	:	48072-0914
Country	:	US
Telephone Number	:	248-546-2133
Fax Number	:	248-546-6036

Provider Business Practice Location Address
First Line	:	28747 WOODWARD AVE
Second Line	:
City	:	BERKLEY
State	:	MI
Zip	:	48072-0914
Country	:	US
Telephone Number	:	248-546-2133
Fax Number	:	248-546-6036

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN ADAM SHANBOM
Credential	:	MD
Telephone Number	:	248-546-2133

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	06/10/2014

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Directions to “SPIRO AND SHANBOM MD PC ” Practice Location

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