CHARLES J SHANLEY (NPI# 1689614141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689614141 |
| Entity Type | Individual |
| Full Name | CHARLES J SHANLEY |
| Credential | MD |
| Practice Address |
16815 E Jefferson Ave Ste 240 Grosse Pointe MI 48230-1923 |
| Mailing Address |
26901 Beaumont Blvd Ste 3d Southfield MI 48033-3849 |
| Practice Telephone | 3134734690 |
| Practice Fax Number | 2485513023 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-10-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
4301051382 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
16815 E JEFFERSON AVE STE 240 |
| City | GROSSE POINTE |
| State | MI |
| Zip Code | 48230-1923 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902285752 | Barry Philip Rosen | Obstetrics & Gynecology | 16815 E Jefferson Ave Ste 240, Grosse Pointe, MI 48230-1923 | 2015-05-27 |
| 1124225248 | Ali Alhousseini | Obstetrics & Gynecology | 16815 E Jefferson Ave Ste 240, Grosse Pointe, MI 48230-1923 | 2007-07-02 |
| 1639389893 | Joseph Anthony Rakowski | Obstetrics & Gynecology | 16815 E Jefferson Ave Ste 240, Grosse Pointe, MI 48230-1923 | 2007-05-23 |
| 1558497206 | Michael C. Coello | Surgery | 16815 E Jefferson Ave Ste 240, Grosse Pointe, MI 48230-1923 | 2007-02-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518573450 | Burd Home Health LLC | In Home Supportive Care | 15001 Kerchezal Ave Unit #2042, Grosse Point Park, MI 48230 | 2020-09-16 |
| 1962924886 | Michelle Kathleen Harr | Speech-Language Pathologist | 1356 Bishop Rd, Grosse Pointe Park, MI 48230 | 2017-07-12 |
| 1356711766 | Jerry George Idicula | Behavioral Analyst | 1332 Maryland St, Grosse Pointe Park, MI 48230 | 2015-09-28 |
| 1578939930 | Sierra Gray | Contractor | 890 Cadieux, Grosse Pointe, MI 48230 | 2015-08-19 |
| 1023413853 | Cristovao Bartolo Carreira | Psychologist | 15450 E. Jefferson, Suite 200, Grosse Pointe, MI 48230 | 2014-10-22 |
| 1215217005 | Nui Loa PC | Community/Behavioral Health | 502 Pemberton, Grosse Pointe Park, MI 48230 | 2011-08-24 |
| 1295041846 | Greg Washington LLC | Psychiatry & Neurology | 793 Harcourt, Grosse Pointe Park, MI 48230 | 2010-08-20 |
| 1649445867 | Philip Charles Hessburg | Ophthalmology | 15415 E Jefferson Street, Grosse Pointe Park, MI 48230 | 2008-04-29 |
| 1437289071 | John Boyd Krisel Jr. | Social Worker | 15200 E Jefferson, Suite 105, Grosse Pointe Park, MI 48230 | 2007-03-06 |
| 1346382819 | Robert James Sisler | Social Worker | 15200 East Jefferson, Suite 105, Grosse Pointe Park, MI 48230 | 2007-02-13 |
| Find all providers in zip 48230 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942561428 | Charles J Shanley Md PC | Surgery | 1001 Audubon Rd, Grosse Pointe, MI 48230-1406 | 2012-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437660057 | Iha Health Services Corporation | Surgery | 5333 Mcauley Dr Rm 4016, Ypsilanti, MI 48197-1001 | 2017-10-23 |
| 1760900138 | Integrated Vascular Vein Center of Michigan PC | Surgery | 600 Health Park Blvd Ste G, Grand Blanc, MI 48439-2558 | 2017-09-06 |
| 1770036147 | Joseph P. Elliott Jr. | Surgery | 3282 Woodview Lake Rd, West Bloomfield, MI 48323-3570 | 2016-08-02 |
| 1043676661 | Integrative Cardiovascular Health & Wellness | Surgery | 3250 Woods Way, Suite 9, Petoskey, MI 49770-7628 | 2016-01-12 |
| 1124411244 | Vascular Surgery Assoc, PC | Surgery | 1122 S Lapeer Rd Ste C, Lapeer, MI 48446-3387 | 2015-03-13 |
| 1013309988 | Bloomfield Vein & Vascular Pllc | Surgery | 43700 Woodward Ave Ste 207, Bloomfield Hills, MI 48302-5061 | 2015-03-02 |
| 1114288206 | Scott Bendix | Surgery | 28100 Grand River Ave Ste 200, Farmington Hills, MI 48336-5969 | 2012-06-05 |
| 1508122995 | Robert J Cardwell Md Pllc | Surgery | 13312 Terry Dr, Shelby Township, MI 48315-5365 | 2012-04-10 |
| 1780919936 | Martin A V Tuma Md Vascular Surgery Pllc | Surgery | 22255 Greemfield Road #250, Southfield, MI 48075 | 2009-10-06 |
| 1437383197 | Barbara D'agnoluzzo Moreira | Surgery | 3663 Woodward Ave Ste 200, Wsu Detroit Medical Center, Detroit, MI 48201-2400 | 2009-05-11 |
| Find all providers with the same taxonomy | ||||
| City | GROSSE POINTE |
| Zip Code | 48230 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.