Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 35.057234 | OH |
NPI | 1831273069 |
---|---|
Provider Name | Dr. M. Shank |
First Address | Chillicothe, OH 45601-8603 |
Second Address | Chillicothe, OH 45601-8603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 10/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2058053 | (05) | OH |
G55792 | (02) | OH |