Healthcare Provider Details

I. General information

NPI: 1194770453
Provider Name (Legal Business Name): DAVID B SHUSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 LINCOLN PARK BLVD STE 255
KETTERING OH
45429-3493
US

IV. Provider business mailing address

2312 FAR HILLS AVE #349
DAYTON OH
45419-1512
US

V. Phone/Fax

Practice location:
  • Phone: 937-266-4668
  • Fax: 866-839-8449
Mailing address:
  • Phone: 937-266-4668
  • Fax: 866-839-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number35-05-9855-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: