Provider Demographics
NPI:1720056336
Name:SHANK, MICHAEL F (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:SHANK
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 1:5020 N NEVADA AVE
Mailing Address - Street 2:BLDG K
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8609
Mailing Address - Country:US
Mailing Address - Phone:206-395-7870
Mailing Address - Fax:
Practice Address - Street 1:4190 E WOODMEN RD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8075
Practice Address - Country:US
Practice Address - Phone:719-632-4455
Practice Address - Fax:719-633-4613
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-004716-L207Q00000X
CODR.0061679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000860737Medicaid
PA084179UCAMedicare ID - Type Unspecified