MICHAEL DIXON SHANE M.D. NPI 1154401990

NPI Information

NPI: 1154401990
Provider Name: MICHAEL DIXON SHANE, M.D.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Address:
121 SOTOYOME ST
SANTA ROSA, CA
ZIP 95405
Phone: (707) 546-4062
Get Directions

Michael Dixon Shane, M.D. is a diagnostic radiology radiology in Santa Rosa, CA. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Michael Dixon Shane, M.D. NPI is 1154401990. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

121 SOTOYOME ST
SANTA ROSA, CA
ZIP 95405-823
Phone: (707) 546-4062
Fax: (707) 578-6258

The enumeration date for this NPI number is 10/16/2006 and was last updated on 7/7/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085B0100X	Radiology	Body Imaging	C30136	CALIFORNIA	No
2	2085N0904X	Radiology	Nuclear Radiology	C30136	CALIFORNIA	No
3	2085U0001X	Radiology	Diagnostic Ultrasound	C30136	CALIFORNIA	No
4	2085R0202X	Radiology	Diagnostic Radiology	C30136	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	00C301360	MEDICARE ID-TYPE UNSPECIFIED
2	00C301360	MEDICAID	CALIFORNIA
3	A34127	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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