Healthcare Provider Details

I. General information

NPI: 1770087678
Provider Name (Legal Business Name): CHRISTOPHER MARK SHUMRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 DIXMYTH AVE # 8
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

379 DIXMYTH AVE # 8
CINCINNATI OH
45220-2475
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-9000
  • Fax: 513-246-7521
Mailing address:
  • Phone: 513-853-9000
  • Fax: 513-246-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberU1767
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number35.150493
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: