Basic Information
| Provider Information | |||||||||
| NPI: | 1699716209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHONK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7440 WOOD MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452433073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132713671 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7700 UNIVERSITY CT | ||||||||
| Address2: | SUITE # 3100 | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450696542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758264 | ||||||||
| FaxNumber: | 5134758265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 06/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35043639S | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 35043639S | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0408320 | 05 | OH | MEDICAID | 942460636061 | 01 | OH | CARESOURCE | OTHER | P00194556 | 01 | OH | MEDICARE TRAVELERS RR-GA | OTHER |