Healthcare Provider Details

I. General information

NPI: 1700774692
Provider Name (Legal Business Name): HAROLD PRETORIUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4743 CORNELL RD
BLUE ASH OH
45241-2432
US

IV. Provider business mailing address

4743 CORNELL RD
BLUE ASH OH
45241-2432
US

V. Phone/Fax

Practice location:
  • Phone: 513-561-3797
  • Fax: 513-561-4043
Mailing address:
  • Phone: 513-561-3797
  • Fax: 513-561-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE BODNAR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 513-561-3797