Healthcare Provider Details

I. General information

NPI: 1144229899
Provider Name (Legal Business Name): GREATER CINCINNATI CARDIOVASCULAR CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVENUE SUITE 624
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVENUE SUITE 624
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-4222
  • Fax: 513-751-4353
Mailing address:
  • Phone: 513-751-4222
  • Fax: 513-751-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35031105
License Number StateOH

VIII. Authorized Official

Name: F. THOMAS JENIKE
Title or Position: PRESIDENT
Credential: MD
Phone: 513-751-4222