Healthcare Provider Details

I. General information

NPI: 1326024845
Provider Name (Legal Business Name): ROBERT F SHADEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6089 FRANTZ RD SUITE 102
DUBLIN OH
43017-3326
US

IV. Provider business mailing address

19900 STATE ROUTE 739
MARYSVILLE OH
43040-9256
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-1300
  • Fax: 614-889-0447
Mailing address:
  • Phone: 937-642-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number35077295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: