G. Daniel Shanahan IV DPM PC
Organization Active NPI Foot & Ankle Surgery Podiatrist · Commerce TWP, MI
NPI 1053417816 · NPPES record last updated Mar 19, 2015
Key facts
- NPI
- 1053417816
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- Legal business name
- G. DANIEL SHANAHAN IV DPM PC
- Practice address
- 9640 Commerce Rd Ste 102
Commerce TWP, MI 48382-4167 - Phone
- (248) 360-3888
- Fax
- (248) 363-0894
- NPI assigned
- Sep 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. George Daniel Shanahan IV, DPM
- Title
- Owner
- Phone
- (248) 360-3888
Practitioners 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031120000529 | MI | Part B Supplier - Clinic/Group Practice | 2961306105 |
Receives reassigned benefits from 2 practitioners Practice locations: Commerce Township, MI |
| O20100930082459 | MI | DME Supplier - Physician - Podiatry | 2961306105 | Practice locations: Commerce Township, MI |
National Provider Directory
Locations
8081 Commerce Rd
Commerce Twp, MI 48382
Phone (248) 360-3888
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist |
213ES0103X | Yes |
Addresses
Primary practice location
9640 Commerce Rd Ste 102
Commerce TWP, MI 48382-4167
Mailing address
9640 Commerce Rd Ste 102
Commerce TWP, MI 48382-4167
Phone (248) 360-3888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770712358 | Other | JENNIFER L PETRONELLA DPM NPI NUMBER | |
| 5901002333 | Other | MI | JENNIFER L PETRONELLA DPM STATE LICENSE |
| 5901001605 | Other | MI | G DANIEL SHANAHAN IV DPM STATE LICENSE |
| N78970 | Other | MEDICARE GROUP NUMBER | |
| 480F321940 | Other | MI | BLUE CROSS BLUE SHIELD |
| 1003818907 | Other | G. D SHANAHAN DPM NPI # | |
| 1790880284 | Other | AIMEE A. POPOFSKI DPM NPI NUMBER | |
| 5901002236 | Other | MI | AIMEE A. POPOFSKI STATE LICENSE |
Other providers in Commerce TWP, MI
- Alan L Feldman
- Linda F Fershtman
- Julie Finn
- Christopher Franke
- Rileigh Freeman
- Alexander John Gammo
- Jennifer Gavia
- Blair Joseph Globerman
- Margaret A Glynn
- Max David Gosselin
All providers in Commerce TWP, MI · Foot & Ankle Surgery Podiatrist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.