Healthcare Provider Details

I. General information

NPI: 1164503355
Provider Name (Legal Business Name): JEAN M ELWING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDEN AVE
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

200 EDEN AVE
CINCINNATI OH
45219-4231
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8523
  • Fax: 513-475-7327
Mailing address:
  • Phone: 513-475-8523
  • Fax: 513-475-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.082870
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.082870
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.082870
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: