MEDICARE: NINA SHANK 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	207T00000X	Neurological Surgery Physician	4351049981	MI

General Provider Information

NPI Number	:	1770088171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA SHANK MD

Provider Business Mailing Address
First Line	:	25 MICHIGAN ST NE STE 6100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2561
Country	:	US
Telephone Number	:	616-267-7900
Fax Number	:	616-267-7901

Provider Business Practice Location Address
First Line	:	25 MICHIGAN ST NE STE 6100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2561
Country	:	US
Telephone Number	:	616-267-7900
Fax Number	:	616-267-7901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	06/28/2022

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