Provider Demographics
NPI:1619167236
Name:SHIE, SCOTT DAVID (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:SHIE
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:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 FOX RD STE 105
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2490
Practice Address - Country:US
Practice Address - Phone:419-232-6051
Practice Address - Fax:419-232-6052
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094960208800000X, 208800000X
IN01069915A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201021740Medicaid
IN000000721639OtherANTHEM
OH3160252Medicaid
OH3160252Medicaid
INM400050505Medicare PIN