Provider Demographics
NPI:1275538720
Name:SHAUB, TED F (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:F
Last Name:SHAUB
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 1:75 ARCH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1431
Mailing Address - Country:US
Mailing Address - Phone:330-374-0009
Mailing Address - Fax:330-374-5693
Practice Address - Street 1:75 ARCH ST STE 206
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1431
Practice Address - Country:US
Practice Address - Phone:330-374-0009
Practice Address - Fax:330-374-5693
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050617S207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0651852Medicaid
OH0626812OtherMEDICARE ID
OH0626816OtherMEDICARE ID
OH0626816OtherMEDICARE ID