Provider Demographics
NPI:1861629354
Name:SHANK, COLLEEN FRANCES (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:FRANCES
Last Name:SHANK
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:FRANCES
Other - Last Name:LAHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:205 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1753
Mailing Address - Country:US
Mailing Address - Phone:517-788-4800
Mailing Address - Fax:
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-917-8507
Practice Address - Fax:941-917-8551
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019612207P00000X
FLOS11233207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine