Shannon Doherty, CRNA | |
30200 Telegraph Rd, Suite 220, Bingham Farms, MI 48025-4502 | |
(248) 258-5058 | |
Not Available |
Full Name | Shannon Doherty |
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Gender | Female |
Speciality | Nurse Anesthetist, Certified Registered |
Location | 30200 Telegraph Rd, Bingham Farms, Michigan |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1295791580 | NPI | - | NPPES |
104838402 | Medicaid | MI | |
P00311232 | Other | MI | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
367500000X | Nurse Anesthetist, Certified Registered | 4704140193 (Michigan) | Primary |
Entity Name | Northstar Anesthesia Of Michigan Ii Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1437268026 PECOS PAC ID: 7911895164 Enrollment ID: O20040309000625 |
Entity Name | Superior Anesthetists Associates Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1831144518 PECOS PAC ID: 5890784987 Enrollment ID: O20040512000785 |
Mailing Address | Practice Location Address |
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Shannon Doherty, CRNA 5445 Myron Rd, Grant Township, MI 48032-2403 Ph: () - | Shannon Doherty, CRNA 30200 Telegraph Rd, Suite 220, Bingham Farms, MI 48025-4502 Ph: (248) 258-5058 |
Michele Burke, CRNA Nurse Anesthetist - CR Medicare: May Accept Medicare Assignments Practice Location: 30200 Telegraph Rd, Suite 220, Bingham Farms, MI 48025 Phone: 248-258-5058 | |
Paul Santoro, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 30200 Telegraph Rd, Suite 220, Bingham Farms, MI 48025 Phone: 248-258-5058 | |
Philip Biland, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 30200 Telegraph Rd, Suite 220, Bingham Farms, MI 48025 Phone: 248-258-5058 | |
Timothy Marx, CRNA Nurse Anesthetist - CR Medicare: May Accept Medicare Assignments Practice Location: 30200 Telegraph Rd, Suite 220, Bingham Farms, MI 48025 Phone: 248-258-5058 | |
Julie Staczek-marx, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 30200 Telegraph Rd, Suite 220, Bingham Farms, MI 48025 Phone: 248-258-5058 | |
Michael Bonds, CRNA Nurse Anesthetist - CR Medicare: May Accept Medicare Assignments Practice Location: 30200 Telegraph Rd, Suite 220, Bingham Farms, MI 48025 Phone: 248-258-5058 | |
Treavor Eimers, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 30200 Telegraph Rd, #220, Bingham Farms, MI 48025 Phone: 248-258-5058 Fax: 248-927-5058 |