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Individual

CHARLES B SHANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
205 SYCAMORE HILLS CT, LOUISVILLE, KY 40245-5095
(502) 243-8330
(502) 243-8330
Mailing address
205 SYCAMORE HILLS CT, LOUISVILLE, KY 40245-5095
(502) 243-8330
(502) 243-8330

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
02/10/2006
Last updated
06/18/2009
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