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NPI Code Detail

MEDICARE: JONATHAN EVAN SHOAG MD

MEDICARE: JONATHAN EVAN SHOAG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician298598NY
2390200000XStudent in an Organized Health Care Education/Training Program
3208800000XUrology Physician35.139170OH

General Provider Information

NPI Number : 1801162292
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN EVAN SHOAG MD
Provider Business Mailing Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-3299
Fax Number :
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-3299
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2012
Last Update Date : 01/10/2021

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