Provider Demographics
NPI:1922042498
Name:SHANK, REED A (MD)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:A
Last Name:SHANK
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 1:237 WILLIAM HOWARD TAFT, PHYS DIV
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-721-7373
Practice Address - Fax:513-977-4253
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.053600208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0667025OtherMEDICARE
OH1922042498OtherMEDICAL MUTUAL
OH448009OtherWELLCARE
OH1632137OtherGATEWAY HEALTH
OH2015312OtherMEDICAID
OHP00861054OtherRAILROAD MEDICARE
OH2015312Medicaid
OH4120714OtherAETNA
OH665925OtherANTHEM
OH744428/676742OtherBUCKEYE MEDICAID/MEDICARE
KY64863970Medicaid
OH2015312OtherMEDICAID
OH0667025OtherMEDICARE