Healthcare Provider Details

I. General information

NPI: 1275599748
Provider Name (Legal Business Name): ANDREW T FILAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 BURNET AVE STE 406
CINCINNATI OH
45229-3022
US

IV. Provider business mailing address

PO BOX 636256
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8600
  • Fax: 513-584-8620
Mailing address:
  • Phone: 513-585-5501
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35043551F
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: