Provider Demographics
NPI:1881697894
Name:SHANNON, KEVIN J (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:SHANNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1900 S MAIN ST
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1214
Mailing Address - Country:US
Mailing Address - Phone:419-423-5262
Mailing Address - Fax:419-423-5550
Practice Address - Street 1:15990 MEDICAL DR S
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8894
Practice Address - Country:US
Practice Address - Phone:419-422-9898
Practice Address - Fax:419-429-0805
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0053829207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH337540Medicare PIN
MDH19801Medicare UPIN