Provider Demographics
NPI:1609182898
Name:MICHAEL, SHON GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHON
Middle Name:GEORGE
Last Name:MICHAEL
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 1:4805 MONTGOMERY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2280
Mailing Address - Country:US
Mailing Address - Phone:513-241-2370
Mailing Address - Fax:513-241-6053
Practice Address - Street 1:4805 MONTGOMERY RD STE 410
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212
Practice Address - Country:US
Practice Address - Phone:513-241-2370
Practice Address - Fax:513-240-6053
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.00130782084N0400X
CT530982084N0400X
OH35.1329012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1024964Medicaid
VT1024964Medicaid