Provider Demographics
NPI:1497724843
Name:SERFLING, SHANE A (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:A
Last Name:SERFLING
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:PO BOX 710725
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0725
Mailing Address - Country:US
Mailing Address - Phone:440-716-1283
Mailing Address - Fax:440-716-1605
Practice Address - Street 1:1120 POLARIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4042
Practice Address - Country:US
Practice Address - Phone:614-847-1120
Practice Address - Fax:614-847-1205
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008486207P00000X
IL036118188207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36118188OtherBCBS
ILP00936461OtherRRMCARE THRU CESIISC (GES)
IL0361181882Medicaid
OH2568234Medicaid
OH000000209264OtherANTHEM
ILP00936459OtherRRMCARE THRU CESIISC (GES)
IL036118188Medicaid
ILP00415663OtherRAILROAD MEDICARE
ILP00936459OtherRRMCARE THRU CESIISC (GES)
ILP00936461OtherRRMCARE THRU CESIISC (GES)
IL036118188Medicaid
ILIL5306007Medicare PIN