MEDICARE: SHANE MICHAEL MATHENY D.O.

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	207R00000X	Internal Medicine Physician	5101016514	MI
2	207RC0000X	Cardiovascular Disease Physician	34.010046	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1831301548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE MICHAEL MATHENY D.O.

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 REFUGEE RD STE 310
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9653
Country	:	US
Telephone Number	:	614-788-4390
Fax Number	:	614-788-4399

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/14/2021

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