Basic Information
| Provider Information | |||||||||
| NPI: | 1639185770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAW | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8099 CORNELL RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452492231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137933933 | ||||||||
| FaxNumber: | 5137938299 | ||||||||
| Practice Location | |||||||||
| Address1: | 8099 CORNELL RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452492231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137933933 | ||||||||
| FaxNumber: | 5137938299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 04/01/2009 | ||||||||
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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 | 207XX0005X | 35-07-4581-S | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00139146 | 01 | OH | MEDICARE RAILROAD | OTHER | 2531602 | 05 | OH | MEDICAID |