Provider Demographics
NPI:1184845331
Name:SPIRO AND SHANBOM MD PC
Entity Type:Organization
Organization Name:SPIRO AND SHANBOM MD PC
Other - Org Name:SHANBOM EYE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SHANBOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-546-2133
Mailing Address - Street 1:28747 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0914
Mailing Address - Country:US
Mailing Address - Phone:248-546-2133
Mailing Address - Fax:248-546-6036
Practice Address - Street 1:28747 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0914
Practice Address - Country:US
Practice Address - Phone:248-546-2133
Practice Address - Fax:248-546-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054486174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104141179Medicaid
MICA2010OtherRAILROAD MEDICARE
MI0F36312Medicare PIN