Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane T Mallon, MD

Individual provider Diagnostic Radiology Physician · NPI 1750709119

Shane T Mallon, MD is a Diagnostic Radiology in Ann Arbor, Michigan. Qualified in 2014, 12 years ago. Practices with Sanford Clinic, a 56-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida, Michigan and North Dakota.

Years since qualifying
12
Licensed in
FL, MI, ND
In the registry since
2014
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone: (734) 936-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4250 Hospital Dr, Marianna, FL 32446-1917 — (850) 526-2200

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 22748 (ND)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence ME175471 (FL)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 4301105443 (MI)

Record details

NPI number1750709119
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 2, 2014
Last updated in NPPESDecember 1, 2025
Certification dateDecember 1, 2025
Mailing address3621 S State St, Ann Arbor, MI 48108-1633

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Also practisesINTERVENTIONAL RADIOLOGY
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Sanford Clinic — 56 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations19 on file with Medicare

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