Individual
DR. GEORGE DANIEL SHANAHAN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
9640 COMMERCE RD STE 102, COMMERCE TWP, MI 48382-4167
(248) 360-3888
(248) 363-0894
Mailing address
9640 COMMERCE RD STE 102, COMMERCE TWP, MI 48382-4167
(248) 360-3888
(248) 363-0894
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
GDS001605
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130147
CARE CHOICES
MI
05
—
297370213
—
MI
01
—
38-3128264
TAX ID
—
01
—
4778520001
DME ADMINISTAR FEDERAL
—
01
—
5631126
BLUE CROSS BLUE SHIELD
MA
01
—
GDS001605
STATE LICENSE
MI
01
—
U43179
HAP
MI
Enumeration date
08/11/2005
Last updated
12/19/2011
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