Individual
CHARLES J SHANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16815 E JEFFERSON AVE STE 240, GROSSE POINTE, MI 48230-1923
(313) 473-4690
(248) 551-3023
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
4301051382
MI
Other
Enumeration date
06/06/2006
Last updated
10/22/2020
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