Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 5151013433 | MI |
NPI | 1003475765 |
---|---|
Provider Name | Alexander Michael Shannon |
First Address | Lansing, MI 48912-1811 |
Second Address | Lansing, MI 48912-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2019 |
Last Update Date | 06/06/2019 |