Provider Demographics
NPI:1609182898
Name:MICHAEL, SHON GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:SHON
Middle Name:GEORGE
Last Name:MICHAEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 MONTGOMERY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2280
Mailing Address - Country:US
Mailing Address - Phone:513-241-2370
Mailing Address - Fax:513-241-6053
Practice Address - Street 1:4805 MONTGOMERY RD STE 410
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212
Practice Address - Country:US
Practice Address - Phone:513-241-2370
Practice Address - Fax:513-240-6053
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132901204D00000X, 2084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0288790Medicaid
KY7100542460Medicaid
IN300033210Medicaid