Basic Information
| Provider Information | |||||||||
| NPI: | 1750384871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALMQUIST | ||||||||
| FirstName: | MARVIN | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3145 HAMILTON MASON RD STE 202B | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD TOWNSHIP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450118556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138944121 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3145 HAMILTON MASON RD STE 202B | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD TOWNSHIP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450118556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138944121 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35068719A | OH | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 35.068719 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2054119 | 05 | OH | MEDICAID | 311575051021 | 01 | OH | TRICARE | OTHER | P00280674 | 01 | OH | MEDICARE RAILROAD | OTHER | 000000332661 | 01 | OH | ANTHEM | OTHER | 287918 | 01 | OH | AMERIGROUP | OTHER | 07-04050 | 01 | OH | UNITED HEALTHCARE | OTHER | 311575051043 | 01 | OH | CARESOURCE | OTHER | 5436630 | 01 | OH | AETNA | OTHER | 311575051020 | 01 | OH | TRICARE | OTHER | 50162967014 | 01 | OH | MEDICAL MUTUAL | OTHER |