Charles J Shanley MD PC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

4301051382 Issued in MI

Legal business name

CHARLES J SHANLEY MD PC

Practice address

1001 Audubon Rd
Grosse Pointe, MI 48230-1406

Phone

(313) 268-7391

NPI assigned

May 31, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles J Shanley, MD

Title

Physician Owner

Phone

(313) 268-7391

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338422400000",
    "number": "1942561428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 AUDUBON RD",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482301406",
            "telephone_number": "313-268-7391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 AUDUBON RD",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482301406",
            "telephone_number": "313-268-7391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES J SHANLEY MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2012-05-31",
        "status": "A",
        "authorized_official_last_name": "SHANLEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "313-268-7391",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301051382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Grosse Pointe, MI
• Vascular Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.