Provider Demographics
NPI:1639185770
Name:SHAW, KEVIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:SHAW
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 1:8099 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2231
Mailing Address - Country:US
Mailing Address - Phone:513-793-3933
Mailing Address - Fax:513-793-8299
Practice Address - Street 1:8099 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2231
Practice Address - Country:US
Practice Address - Phone:513-793-3933
Practice Address - Fax:513-793-8299
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4581-S207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00139146OtherMEDICARE RAILROAD
OH2531602Medicaid
OH2531602Medicaid
OHSH4135741Medicare ID - Type Unspecified