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NPI Code Detail

MEDICARE: DR. SHAHED TISH MD

MEDICARE: DR. SHAHED TISH 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
1208600000XSurgery Physician35.156237OH
2208600000XSurgery Physician79527MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
135.156237OTHEROHLICENSE

General Provider Information

NPI Number : 1669033114
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAHED TISH MD
Provider Business Mailing Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 216-444-2200
Fax Number : --
Provider Business Practice Location Address
First Line : 18101 LORAIN AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-5612
Country : US
Telephone Number : 216-476-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2019
Last Update Date : 06/05/2026

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Directions to “ DR. SHAHED TISH MD” Practice Location

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