Marvin D Shie III, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35-035105 Issued in OH

Practice address

15644 Madison Avenue
Suite 107
Lakewood, OH 44107-5622

Phone

(216) 221-7400

Fax

(216) 221-7950

NPI assigned

Dec 9, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Premier Physicians Centers, Inc.

  • Internal Medicine Physician
  • Westlake, OH
  • NPI 1780634279
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265932800000",
    "number": "1083699227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 74692",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441940002",
            "telephone_number": "440-895-5021",
            "fax_number": "440-895-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15644 MADISON AVENUE",
            "address_2": "SUITE 107",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441075622",
            "telephone_number": "216-221-7400",
            "fax_number": "216-221-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIE",
        "first_name": "MARVIN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2010-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35035105S",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35-035105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0377999",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CA4511",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "341318336",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riya Shanavas
• Kristian Taylor Shaw, PA-C
• Sheila Becking, Psy.D., LLC
• Ronald Edward Shelton Jr.
• Cecilia Sherrard
• Shift Theory Counseling LLC
• Renae Shire
• Cristian N Shofar, PCC-S
• Anne E Sierk, MD
• Jaeda Denise Siggers, LPN

• Surgery Physician in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.