Provider Demographics
NPI:1144243098
Name:SHINE, STEVEN B (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:SHINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 S EDISON DR
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-9318
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:280 BENEDICT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2374
Practice Address - Country:US
Practice Address - Phone:419-663-5000
Practice Address - Fax:419-663-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-003935207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH200041548OtherMEDICARE RAILROAD
OH4258080005OtherDME NUMBER
OH0651138Medicaid
OH200041548OtherMEDICARE RAILROAD
OH0653415Medicare ID - Type Unspecified
OH4258080005Medicare NSC