Healthcare Provider Details

I. General information

NPI: 1326200205
Provider Name (Legal Business Name): YOUR MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8250 KENWOOD CROSSING WAY SUITE 225
CINCINNATI OH
45236-3670
US

IV. Provider business mailing address

PO BOX 633883
CINCINNATI OH
45263-3883
US

V. Phone/Fax

Practice location:
  • Phone: 513-721-9600
  • Fax: 513-721-1649
Mailing address:
  • Phone: 513-721-9600
  • Fax: 513-721-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE C CORSER
Title or Position: MD/OWNER
Credential: MD
Phone: 513-721-9600