Provider Demographics
NPI:1376692855
Name:MCMANN, SHANNON N (DO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:N
Last Name:MCMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36500 S GRATIOT AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1772
Mailing Address - Country:US
Mailing Address - Phone:586-790-9003
Mailing Address - Fax:586-493-3603
Practice Address - Street 1:36500 S GRATIOT AVE
Practice Address - Street 2:STE 102
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-1772
Practice Address - Country:US
Practice Address - Phone:586-790-9003
Practice Address - Fax:586-493-3603
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MISM014297207R00000X
MI5101014297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH68105Medicare UPIN
MIOM95600003Medicare PIN