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NPI Code Detail

MEDICARE: TIMELESS AESTHETICS, LLC

MEDICARE: TIMELESS AESTHETICS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician1594262OH

General Provider Information

NPI Number : 1194950550
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIMELESS AESTHETICS, LLC
Provider Business Mailing Address
First Line : 3260 WESTBOURNE DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45248-5107
Country : US
Telephone Number : 513-451-9600
Fax Number : 513-347-2116
Provider Business Practice Location Address
First Line : 3260 WESTBOURNE DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45248-5107
Country : US
Telephone Number : 513-451-9600
Fax Number : 513-347-2116
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : BETH A ROCH
Credential :
Telephone Number : 513-619-5006
Provider Enumeration Date : 05/28/2009
Last Update Date : 05/28/2009

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Directions to “TIMELESS AESTHETICS, LLC ” Practice Location

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