MEDICARE: DR. STEVEN ADAM SHANBOM 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
1	207W00000X	Ophthalmology Physician	4301054486	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18-0-63-8385-1	OTHER		BCBS
2	5888141	OTHER		AETNA
3	P43246	OTHER		BLUE CARE NETWORK
4	131574	OTHER		CARECHOICES
5	18-0-63-2464-1	OTHER	MI	BCBS
6	0980023	OTHER		HEALTH PLUS

General Provider Information

NPI Number	:	1265433742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ADAM SHANBOM MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/27/2008

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