MEDICARE: DR. SEERIN VIVIANE SHATAVI 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	207R00000X	Internal Medicine Physician	125053868	IL
2	207RH0003X	Hematology & Oncology Physician	130298	OH
3	207RH0003X	Hematology & Oncology Physician	35130298	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	:	1952544561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEERIN VIVIANE SHATAVI M.D.

Provider Business Mailing Address
First Line	:	3035 HAMILTON MASON RD STE 204
Second Line	:
City	:	FAIRFIELD TOWNSHIP
State	:	OH
Zip	:	45011-5545
Country	:	US
Telephone Number	:	513-853-1300
Fax Number	:	513-451-4118

Provider Business Practice Location Address
First Line	:	3035 HAMILTON MASON RD STE 204
Second Line	:
City	:	FAIRFIELD TOWNSHIP
State	:	OH
Zip	:	45011-5545
Country	:	US
Telephone Number	:	513-853-1300
Fax Number	:	513-451-4118

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	11/13/2018

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Directions to “ DR. SEERIN VIVIANE SHATAVI M.D.” Practice Location

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