Individual
SHANE MICHAEL MATHENY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1010 REFUGEE RD STE 310, PICKERINGTON, OH 43147-9653
(614) 788-4390
(614) 788-4399
Mailing address
PO BOX 7527, DUBLIN, OH 43017-0727
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101016514
MI
207RC0000X
Cardiovascular Disease Physician
Primary
34.010046
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0051286
—
OH
Enumeration date
05/04/2007
Last updated
09/14/2021
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