Healthcare Provider Details

I. General information

NPI: 1013066281
Provider Name (Legal Business Name): INFECTIOUS DISEASES CONSULTANTS OF CINCINNATI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 STRAIGHT ST SUITE 400
CINCINNATI OH
45219-1064
US

IV. Provider business mailing address

330 STRAIGHT ST SUITE 400
CINCINNATI OH
45219-1064
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-0999
  • Fax: 513-624-0934
Mailing address:
  • Phone: 513-624-0999
  • Fax: 513-624-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number207RI0200X
License Number StateOH

VIII. Authorized Official

Name: DR. STEPHEN PATRICK BLATT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 513-624-0999