Healthcare Provider Details

I. General information

NPI: 1609182898
Provider Name (Legal Business Name): SHON GEORGE MICHAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 MONTGOMERY RD STE 410
CINCINNATI OH
45212
US

IV. Provider business mailing address

4805 MONTGOMERY RD STE 150
CINCINNATI OH
45212-2280
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-2370
  • Fax: 513-240-6053
Mailing address:
  • Phone: 513-241-2370
  • Fax: 513-241-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number35.132901
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.132901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: