Healthcare Provider Details

I. General information

NPI: 1568508158
Provider Name (Legal Business Name): ARNOLD GLAZER SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 DIXIE HIGHWAY SUITE 200
FT WRIGHT KY
41011
US

IV. Provider business mailing address

1717 DIXIE HIGHWAY SUITE 200
FT WRIGHT KY
41011
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7453
  • Fax: 859-344-3183
Mailing address:
  • Phone: 859-341-7453
  • Fax: 859-344-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22192
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: