Basic Information
| Provider Information | |||||||||
| NPI: | 1609206283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GYNECOLOGIC & OBSTETRIC CONSULTANTS OF GREATER CINCINNATI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2123 AUBURN AVE | ||||||||
| Address2: | #528 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137925800 | ||||||||
| FaxNumber: | 5137925806 | ||||||||
| Practice Location | |||||||||
| Address1: | 2123 AUBURN AVE | ||||||||
| Address2: | #528 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137925800 | ||||||||
| FaxNumber: | 5137925806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2013 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | PRANIKOFF | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5137925800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35-059105 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0821721 | 05 | OH | MEDICAID |