Provider Demographics
NPI:1851398580
Name:SHANKLIN, JOEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:L
Last Name:SHANKLIN
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 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 W MARKET ST STE 260
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2745
Practice Address - Country:US
Practice Address - Phone:419-996-5208
Practice Address - Fax:419-996-5209
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351375492086S0122X
GA485712086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG48571Medicaid
GA300044892AMedicaid
GA00866181BMedicaid
GAG58998Medicare UPIN
SCG48571Medicaid