Justin Shayne Fanning, MD
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Grand Rapids, MI. Individual provider (NPI-1).
Details
- NPI
- 1700908522
- Entity type
- Individual (NPI-1)
- Name
- Justin Shayne Fanning
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 4, 2007
- Certification date
- Mar 14, 2022
- Last updated
- Mar 14, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - THORACIC SURGERY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4301074884 | MI | Yes |
Practice location
221 Michigan St Ne Ste 300Grand Rapids, MI 49503-2537
Phone 616-459-7258 · Fax 616-459-5215
Mailing address
100 Michigan St NeMc 845
Grand Rapids, MI 49503-2560
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