Basic Information
| Provider Information | |||||||||
| NPI: | 1649245325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOBOLEWSKI | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3747 W FORK RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139614335 | ||||||||
| FaxNumber: | 5139614227 | ||||||||
| Practice Location | |||||||||
| Address1: | 3747 W FORK RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139614335 | ||||||||
| FaxNumber: | 5139614227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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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 | 208600000X | 35074319 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 020039337 | 01 | OH | RAILROAD MEDICARE | OTHER | 200177410A | 05 | IN | MEDICAID | 200177410 | 05 | IN | MEDICAID | 64959984 | 05 | KY | MEDICAID | 2066544 | 05 | OH | MEDICAID | 7100056850 | 05 | KY | MEDICAID |