Healthcare Provider Details

I. General information

NPI: 1750200267
Provider Name (Legal Business Name): LONNIE MAULDIN PRS.007252
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12115 SHERATON LN
CINCINNATI OH
45246-1613
US

IV. Provider business mailing address

2943 WESTRIDGE AVE APT 1
CINCINNATI OH
45238-2309
US

V. Phone/Fax

Practice location:
  • Phone: 513-497-4719
  • Fax:
Mailing address:
  • Phone: 513-628-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007252
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: