MEDICARE: DR. NATHAN SHANE D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016005776	IL
2	213E00000X	Podiatrist	36.004061	OH
3	213ES0103X	Foot & Ankle Surgery Podiatrist	36.004061	OH
4	213ES0103X	Foot & Ankle Surgery Podiatrist	111825	WI
5	213ES0103X	Foot & Ankle Surgery Podiatrist	07001318A	IN

General Provider Information

NPI Number	:	1043606247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN SHANE D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 636256
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-585-6200
Fax Number	:	513-245-3672

Provider Business Practice Location Address
First Line	:	7690 DISCOVERY DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6542
Country	:	US
Telephone Number	:	513-475-8690
Fax Number	:	513-475-8629

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

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	06/03/2026

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