Healthcare Provider Details

I. General information

NPI: 1417193681
Provider Name (Legal Business Name): WOUND SPECIALISTS OF GREATER CINCINNATI, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242-4402
US

IV. Provider business mailing address

PO BOX 643911
CINCINNATI OH
45264-3911
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1111
  • Fax: 513-557-3329
Mailing address:
  • Phone: 513-557-3330
  • Fax: 513-557-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-082412
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number35-082412
License Number StateOH

VIII. Authorized Official

Name: ARTI BALAR MASTURZO
Title or Position: OWNER
Credential: MD
Phone: 513-557-3330