Healthcare Provider Details

I. General information

NPI: 1306026158
Provider Name (Legal Business Name): ENT ASSOCIATES OF CINTI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 KENWOOD RD C204
CINCINNATI OH
45242-6895
US

IV. Provider business mailing address

PO BOX 691503
CINCINNATI OH
45269-1503
US

V. Phone/Fax

Practice location:
  • Phone: 513-729-0200
  • Fax: 513-729-0333
Mailing address:
  • Phone: 513-936-0500
  • Fax: 513-936-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35041973
License Number StateOH

VIII. Authorized Official

Name: DR. ALTER G PEERLESS
Title or Position: DOCTOR
Credential: MD
Phone: 513-936-0500