Provider Demographics
NPI:1215930532
Name:SHANI, HEZEKIAH GP (MD)
Entity type:Individual
Prefix:DR
First Name:HEZEKIAH
Middle Name:GP
Last Name:SHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3120 BURNET AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3091
Mailing Address - Country:US
Mailing Address - Phone:513-621-5052
Mailing Address - Fax:513-621-5125
Practice Address - Street 1:3120 BURNET AVE
Practice Address - Street 2:STE 401
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3092
Practice Address - Country:US
Practice Address - Phone:513-621-5052
Practice Address - Fax:513-621-5125
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH54352208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA16738Medicare UPIN