Provider Demographics
NPI:1164439949
Name:SHAHEEN, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SHAHEEN
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 1:570 WHITE POND DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4206
Mailing Address - Country:US
Mailing Address - Phone:330-869-0124
Mailing Address - Fax:330-869-2852
Practice Address - Street 1:570 WHITE POND DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4206
Practice Address - Country:US
Practice Address - Phone:330-869-0124
Practice Address - Fax:330-869-2852
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088782207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000510908OtherBCBS
OH2734027Medicaid
OH8470384OtherCIGNA
OH341296621OtherCHAMPUS
OH750960OtherBUCKEYE MEDICAID
OH341296621OtherTRICARE
OH341296621OtherCARESOURCE
OH341296621FOtherAULTCARE
OHP00420978OtherMEDICARE RAILROAD
OH7696930OtherAETNA
OH341296621OtherCARESOURCE
OHSH4210761Medicare PIN