Provider Demographics
NPI:1619241783
Name:SHANKS, MICHAEL JAMES ELKINS (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES ELKINS
Last Name:SHANKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5501
Mailing Address - Country:US
Mailing Address - Phone:812-201-3807
Mailing Address - Fax:
Practice Address - Street 1:3401 S 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802
Practice Address - Country:US
Practice Address - Phone:812-232-9596
Practice Address - Fax:812-232-7992
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005486A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology