Provider Demographics
NPI:1023013471
Name:SHYBUT, GEORGE THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:THEODORE
Last Name:SHYBUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1318
Mailing Address - Country:US
Mailing Address - Phone:513-753-7488
Mailing Address - Fax:513-753-7879
Practice Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1318
Practice Address - Country:US
Practice Address - Phone:513-753-7488
Practice Address - Fax:513-753-7879
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350559319S207X00000X
KY31910207X00000X
IL036054951207X00000X
IN01041143A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3284491OtherCIGNA
OHP00321556OtherMEDICARE RAILROAD
OH000000382638OtherANTHEM
OH0785011Medicaid
OH0903535OtherUNITED HEALTHCARE
OHP00321556OtherMEDICARE RAILROAD
OHH249190Medicare PIN
OH0903535OtherUNITED HEALTHCARE