Provider Demographics
NPI:1699716209
Name:SHONK, RICHARD FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:FRANCIS
Last Name:SHONK
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 1:7440 WOOD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-3073
Mailing Address - Country:US
Mailing Address - Phone:513-271-3671
Mailing Address - Fax:
Practice Address - Street 1:7700 UNIVERSITY CT
Practice Address - Street 2:SUITE # 3100
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-475-8264
Practice Address - Fax:513-475-8265
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043639S207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0408320Medicaid
OH942460636061OtherCARESOURCE
OHP00194556OtherMEDICARE TRAVELERS RR-GA
OHA79034Medicare UPIN
OH0408320Medicaid