Basic Information
| Provider Information | |||||||||
| NPI: | 1275538720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAUB | ||||||||
| FirstName: | TED | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 ARCH ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303740009 | ||||||||
| FaxNumber: | 3303745693 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 ARCH ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303740009 | ||||||||
| FaxNumber: | 3303745693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35050617S | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 35050617S | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 0651852 | 05 | OH | MEDICAID | 0626812 | 01 | OH | MEDICARE ID | OTHER | 0626816 | 01 | OH | MEDICARE ID | OTHER |