Basic Information
| Provider Information | |||||||||
| NPI: | 1104945062 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SET SHAHBABIAN MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3285 WESTBOURNE DR | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452485130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139224810 | ||||||||
| FaxNumber: | 5139223421 | ||||||||
| Practice Location | |||||||||
| Address1: | 3285 WESTBOURNE DR | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452485130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139224810 | ||||||||
| FaxNumber: | 5139223421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 10/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHAHBABIAN | ||||||||
| AuthorizedOfficialFirstName: | SET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5139224810 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 35044750 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 2085R0202X | 1024IC | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0489421 | 05 | OH | MEDICAID |