Healthcare Provider Details

I. General information

NPI: 1356799456
Provider Name (Legal Business Name): SANDERS OH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 5 MILE RD STE 100
CINCINNATI OH
45230-2187
US

IV. Provider business mailing address

121 E FREEDOM WAY UNIT 326
CINCINNATI OH
45202-3480
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-6980
  • Fax: 513-233-6983
Mailing address:
  • Phone: 312-351-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number332545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: