Basic Information
| Provider Information | |||||||||
| NPI: | 1205155967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOOK | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1649 BENNIGAN DR | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430268160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149492911 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 776 PRIOR HALL | ||||||||
| Address2: | 376 WEST 10TH AVENUE | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142933551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2010 | ||||||||
| LastUpdateDate: | 10/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 23303 | MS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | D77234 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35.125662 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.