Basic Information
| Provider Information | |||||||||
| NPI: | 1730119496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIZER | ||||||||
| FirstName: | GIL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WILLIAM HOWARD TAFT, PHYS DIV | ||||||||
| Address2: | 2ND FL, CBO2-3, ATTN: CREDENTIALING | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132638571 | ||||||||
| FaxNumber: | 5133664480 | ||||||||
| Practice Location | |||||||||
| Address1: | 2123 AUBURN AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137217373 | ||||||||
| FaxNumber: | 5139774253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 01057082 | IN | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 35.098482 | OH | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 132639 | 01 | KY | COVENTRY CARES | OTHER | 654814 | 01 | OH | WELLCARE | OTHER | 270577733066 | 01 | OH | CARESOURCE | OTHER | 0059879 | 01 | OH | MEDICAID | OTHER | 700266 | 01 | OH | BUCKEYE - MEDICARE | OTHER | 747737 | 01 | OH | ANTHEM | OTHER | H073800 | 01 | OH | MEDICARE | OTHER | 7249227 | 01 | OH | AETNA | OTHER | 772712 | 01 | BUCKEYE - MEDICAID | OTHER | P01125188 | 01 | OH | RAIDROAD MEDICARE | OTHER |