Individual
MARK R MCSHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AU.D
Contact information
Practice address
1111 W CENTRE AVE, PORTAGE, MI 49024-5317
(269) 324-0301
(269) 324-2387
Mailing address
215 SHUMAN BLVD, SUITE 401, NAPERVILLE, IL 60563-8458
(630) 303-5380
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64OC91290
BLUE CROSS AUDIOLOGY
MI
05
—
804836453
—
MI
Enumeration date
02/26/2007
Last updated
09/12/2013
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