Provider Demographics
NPI:1942319850
Name:ACINO, SHAWN MICHAEL (MD FACS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MICHAEL
Last Name:ACINO
Suffix:
Gender:M
Credentials:MD FACS
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Mailing Address - Street 1:30 MEDPARK SQUARE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1709
Mailing Address - Country:US
Mailing Address - Phone:606-677-8360
Mailing Address - Fax:606-677-8399
Practice Address - Street 1:30 MEDPARK SQUARE DR
Practice Address - Street 2:STE 1
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1709
Practice Address - Country:US
Practice Address - Phone:606-677-8360
Practice Address - Fax:606-677-8399
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL22723208800000X
KY49477208800000X
IN01074322A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100436510Medicaid
KY1942319850OtherHUMANA
KY12063358OtherCAQH
KY1942319850OtherTRICARE
KY50115464OtherPASSPORT
KY1942319850OtherCENTER CARE PPO
KY1942319850OtherUNITED HEALTHCARE
KY000001036081OtherANTHEM BCBS KY
KY1942319850OtherHERITAGE SUMMIT HEALTHCARE
KY1942319850OtherCENTER CARE PPO