CHARLES J SHANLEY MD PC
Radiology at Audubon Rd, Detroit, MI

License number
Michigan 4301051382
Category
Radiology
Type
Vascular Surgery
Owner
Name: CHARLES J SHANLEY MD
Title: PHYSICIAN OWNER
Phone: (313) 268-7391
Address
Address
1001 Audubon Rd, Detroit, MI 48230
National Provider ID: 1942561428
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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CHARLES J. SHANLEY, M.D., PC

Detroit, MI

Registration:
Dec 19, 2011
Addresses:
1001 Audubon, Grosse Pointe, MI 48230 (Physical)
Michigan (Mailing)
State ID:
04455L
Business type:
Domestic Professional Service Corporation
Agent:
Charles J. Shanley, M.d

CHARLES J. SHANLEY, M.D., PC

Detroit, MI

Status:
Inactive
Registration:
Apr 24, 2001
Addresses:
15 Waverly Ln, Grosse Pointe, MI 48236 (Physical)
Michigan (Mailing)
State ID:
03508C
Business type:
Domestic Professional Service Corporation
Expiration:
7-15-2007
Agent:
Charles J Shanley

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