Healthcare Provider Details

I. General information

NPI: 1619901840
Provider Name (Legal Business Name): PRETORIUS AND ROBLES M.D.'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4743 CORNELL RD
CINCINNATI OH
45241-2432
US

IV. Provider business mailing address

4743 CORNELL RD
CINCINNATI OH
45241-2432
US

V. Phone/Fax

Practice location:
  • Phone: 513-561-3797
  • Fax:
Mailing address:
  • Phone: 513-561-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.056690
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31919
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number31919
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number35.056690
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35.056690
License Number StateOH

VIII. Authorized Official

Name: DR. HAROLD THOMAS PRETORIUS
Title or Position: MEDICAL DIRECTOR
Credential: M.D., PH.D.
Phone: 513-561-3797