Organization
CHARLES B SHANE MD PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES B SHANE MD (OWNER PHYSICIAN)
(502) 895-7445
Entity
Organization
Contact information
Practice address
4001 KRESGE WAY, SUITE 315, LOUISVILLE, KY 40207-4640
(502) 895-7445
(502) 895-6638
Mailing address
4001 KRESGE WAY, SUITE 315, LOUISVILLE, KY 40207-4640
(502) 895-7445
(502) 895-6638
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
18903
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000068700
ANTHEM
KY
05
—
64189038
—
KY
Enumeration date
03/06/2007
Last updated
02/24/2009
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