Provider Demographics
NPI:1538144639
Name:SHANKMAN, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SHANKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23625 COMMERCE PARK
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-255-5701
Mailing Address - Fax:216-255-5701
Practice Address - Street 1:30 W 89TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2037
Practice Address - Country:US
Practice Address - Phone:216-255-5700
Practice Address - Fax:216-255-5701
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1505082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
34195845110024OtherTRICARE WEST
OH341958451020OtherMEDICAL MUTUAL
NY71R36OtherBCBS
PA1016624150001Medicaid
AZ12317801Medicaid
209756897OtherTRICARE SOUTH
OH2510769Medicaid
ID807443900Medicaid
NYP00163856OtherRXR MEDICARE
NYA400050817Medicare PIN
OH341958451020OtherMEDICAL MUTUAL
OH2510769Medicaid