Healthcare Provider Details

I. General information

NPI: 1811591936
Provider Name (Legal Business Name): ORTHOLIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3287 HEMLOCK RD
EDGEWOOD KY
41017-3321
US

IV. Provider business mailing address

1311 VINE ST
CINCINNATI OH
45202-7118
US

V. Phone/Fax

Practice location:
  • Phone: 513-479-9102
  • Fax: 513-306-4004
Mailing address:
  • Phone: 866-456-7846
  • Fax: 513-306-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND MICHAEL GREIWE
Title or Position: CEO
Credential: MD
Phone: 668-456-7846