Provider Demographics
NPI:1952433203
Name:WALLS, SHAWN WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:WILLIAM
Last Name:WALLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MERCHANT STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-385-7733
Mailing Address - Fax:513-385-7703
Practice Address - Street 1:5463 N BEND RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7620
Practice Address - Country:US
Practice Address - Phone:513-385-7733
Practice Address - Fax:513-385-7703
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59000193213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200264580Medicaid
OH2950310Medicaid
IN200951110Medicaid
IN200951110Medicaid
OH4261733Medicare PIN
OH4261732Medicare PIN
IN200264580Medicaid
OH4261734Medicare PIN