Provider Demographics
NPI:1912157587
Name:SHANK, JUDITH FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:FRANCES
Last Name:SHANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PEAVEY LN
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1525
Mailing Address - Country:US
Mailing Address - Phone:925-476-0950
Mailing Address - Fax:952-404-0804
Practice Address - Street 1:330 PEAVEY LN
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1525
Practice Address - Country:US
Practice Address - Phone:952-476-0950
Practice Address - Fax:952-404-0804
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28211207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology