Healthcare Provider Details

I. General information

NPI: 1508862749
Provider Name (Legal Business Name): MICHAEL ANTHONY POLICASTRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 QUEEN CITY AVE
CINCINNATI OH
45238-2316
US

IV. Provider business mailing address

6885 SWEETFARM LN
LOVELAND OH
45140-6064
US

V. Phone/Fax

Practice location:
  • Phone: 513-557-3333
  • Fax: 513-557-3332
Mailing address:
  • Phone: 513-774-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01091676A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC175786
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35082976
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: