Healthcare Provider Details

I. General information

NPI: 1528063740
Provider Name (Legal Business Name): JOHN PATRICK ZISKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 GLEN ESTE WITHAMSVILLE RD SUITE 500
CINCINNATI OH
45245-1318
US

IV. Provider business mailing address

4440 GLEN ESTE WITHAMSVILLE RD SUITE 500
CINCINNATI OH
45245-1318
US

V. Phone/Fax

Practice location:
  • Phone: 513-753-7488
  • Fax: 513-753-7879
Mailing address:
  • Phone: 513-753-7488
  • Fax: 513-753-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35-07-0596-Z
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: