Healthcare Provider Details

I. General information

NPI: 1821018524
Provider Name (Legal Business Name): ROBERT R SHENK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER RD
SHAKER HEIGHTS OH
44122-5203
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7874
  • Fax:
Mailing address:
  • Phone: 216-286-6295
  • Fax: 216-286-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-043837
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35043837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: