Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | FS055137 | MI |
NPI | 1023085578 |
---|---|
Provider Name | Francis L Shannon |
First Address | Southfield, MI 48033-3849 |
Second Address | Royal Oak, MI 48073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4627032 | (05) | MI |
E19775 | (02) | MI |