Organization
CHARLES J SHANLEY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J SHANLEY MD (PHYSICIAN OWNER)
(313) 268-7391
Entity
Organization
Contact information
Practice address
1001 AUDUBON RD, GROSSE POINTE, MI 48230-1406
(313) 268-7391
Mailing address
1001 AUDUBON RD, GROSSE POINTE, MI 48230-1406
(313) 268-7391
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
4301051382
MI
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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