Individual
DR. MARVIN D SHIE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15644 MADISON AVENUE, SUITE 107, LAKEWOOD, OH 44107-5622
(216) 221-7400
(216) 221-7950
Mailing address
P.O. BOX 74692, CLEVELAND, OH 44194-0002
(440) 895-5021
(440) 895-5050
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35-035105
OH
208600000X
Surgery Physician
35035105S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0377999
—
OH
01
—
341318336
FEDERAL TAX ID
OH
01
—
CA4511
RR MEDICARE GROUP
—
Enumeration date
12/09/2005
Last updated
02/12/2010
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