MEDICARE: DR. GEORGE THEODORE SHYBUT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	350559319S	OH
2	207X00000X	Orthopaedic Surgery Physician	31910	KY
3	207X00000X	Orthopaedic Surgery Physician	036054951	IL
4	207X00000X	Orthopaedic Surgery Physician	01041143A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00321556	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3284491	OTHER	OH	CIGNA
3	000000382638	OTHER	OH	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0903535	OTHER	OH	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1023013471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE THEODORE SHYBUT M.D.

Provider Business Mailing Address
First Line	:	4440 GLEN ESTE WITHAMSVILLE RD
Second Line	:	SUITE 500
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1318
Country	:	US
Telephone Number	:	513-753-7488
Fax Number	:	513-753-7879

Provider Business Practice Location Address
First Line	:	4440 GLEN ESTE WITHAMSVILLE RD
Second Line	:	SUITE 500
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1318
Country	:	US
Telephone Number	:	513-753-7488
Fax Number	:	513-753-7879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/23/2013

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Directions to “ DR. GEORGE THEODORE SHYBUT M.D.” Practice Location

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