Healthcare Provider Details

I. General information

NPI: 1104487263
Provider Name (Legal Business Name): NATHANIEL JOSEPH BALMERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2489
US

IV. Provider business mailing address

10191 EVENDALE COMMONS DR
CINCINNATI OH
45241-2689
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-1400
  • Fax:
Mailing address:
  • Phone: 513-817-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.151159
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: