Basic Information
| Provider Information | |||||||||
| NPI: | 1841487535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACHUS | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4685 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452123397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534722 | ||||||||
| FaxNumber: | 5138528525 | ||||||||
| Practice Location | |||||||||
| Address1: | 7423 S MASON MONTGOMERY RD STE B | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450407828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133983445 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A95201 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.123771 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0111259 | 05 | OH | MEDICAID |