Healthcare Provider Details

I. General information

NPI: 1124470489
Provider Name (Legal Business Name): REN-SHUOH KUO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 E GALBRAITH RD STE 212
CINCINNATI OH
45236-6704
US

IV. Provider business mailing address

4805 MONTGOMERY RD STE 150
CINCINNATI OH
45212-2280
US

V. Phone/Fax

Practice location:
  • Phone: 513-829-1700
  • Fax: 513-310-4019
Mailing address:
  • Phone: 513-961-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.016509
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number34.016509
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: