Healthcare Provider Details

I. General information

NPI: 1275538720
Provider Name (Legal Business Name): TED F SHAUB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST STE 206
AKRON OH
44304-1431
US

IV. Provider business mailing address

75 ARCH ST STE 206
AKRON OH
44304-1431
US

V. Phone/Fax

Practice location:
  • Phone: 330-374-0009
  • Fax: 330-374-5693
Mailing address:
  • Phone: 330-374-0009
  • Fax: 330-374-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35050617S
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35050617S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: