Provider Demographics
NPI:1679765127
Name:M. V. SHETTY M.D., INC.
Entity type:Organization
Organization Name:M. V. SHETTY M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHNI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-661-5500
Mailing Address - Street 1:3317 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6510
Mailing Address - Country:US
Mailing Address - Phone:513-661-5500
Mailing Address - Fax:
Practice Address - Street 1:3317 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6510
Practice Address - Country:US
Practice Address - Phone:513-661-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2252011Medicaid
OH9312701OtherMEDICARE PROVIDER NUMBER
OH=========Medicare PIN
OH2252011Medicaid