# CHARLES J SHANLEY MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942561428
- **Authorized official:** CHARLES J SHANLEY MD (PHYSICIAN OWNER)
- **Authorized official phone:** (313) 268-7391

## Contact information

- **Practice address:** 1001 AUDUBON RD, GROSSE POINTE, MI 48230-1406
- **Practice address phone:** (313) 268-7391
- **Mailing address:** 1001 AUDUBON RD, GROSSE POINTE, MI 48230-1406
- **Mailing address phone:** (313) 268-7391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 4301051382 | MI | Yes |

## Other

- **Enumeration date:** 05/31/2012
- **Last updated:** 05/31/2012