Healthcare Provider Details

I. General information

NPI: 1922042498
Provider Name (Legal Business Name): REED A SHANK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE SUITE 108
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT, PHYS DIV 2ND FL, CBO2-3, ATTN: CREDENTIALING
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-721-7373
  • Fax: 513-977-4253
Mailing address:
  • Phone: 513-263-8571
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.053600
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: