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NPI Code Detail

MEDICARE: DR. JEFFREY F SHALL MD

MEDICARE: DR. JEFFREY F SHALL MD
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
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician35.058254CTROH
2207X00000XOrthopaedic Surgery Physician35058254OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00381215OTHEROHRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134106354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY F SHALL MD
Provider Business Mailing Address
First Line : 7345 EDWARDS LNDG
Second Line :
City : CHAGRIN FALLS
State : OH
Zip : 44023-1429
Country : US
Telephone Number : 216-369-2830
Fax Number :
Provider Business Practice Location Address
First Line : 4700 RICHMOND RD STE 100
Second Line :
City : WARRENSVILLE HEIGHTS
State : OH
Zip : 44128-5985
Country : US
Telephone Number : 216-973-5807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 12/17/2025

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