Healthcare Provider Details

I. General information

NPI: 1023308558
Provider Name (Legal Business Name): JOHN BORA TEZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 KENWOOD RD STE 105
BLUE ASH OH
45242-6252
US

IV. Provider business mailing address

9825 KENWOOD RD STE 105
BLUE ASH OH
45242-6252
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-4500
  • Fax:
Mailing address:
  • Phone: 513-872-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.131885
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: