Provider Demographics
NPI:1306841572
Name:RHEE, SHANG YOUL (MD)
Entity Type:Individual
Prefix:
First Name:SHANG
Middle Name:YOUL
Last Name:RHEE
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 1:5800 MONROE ST
Mailing Address - Street 2:BLDG A
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2263
Mailing Address - Country:US
Mailing Address - Phone:419-885-8449
Mailing Address - Fax:419-882-7621
Practice Address - Street 1:5800 MONROE ST
Practice Address - Street 2:BLDG A
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2263
Practice Address - Country:US
Practice Address - Phone:419-885-8449
Practice Address - Fax:419-882-7621
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033976R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158592Medicaid
OHRH0364723Medicare ID - Type Unspecified
OH0158592Medicaid