Healthcare Provider Details

I. General information

NPI: 1649546748
Provider Name (Legal Business Name): MOSES WANANU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MERCY HEALTH BLVD STE 125
CINCINNATI OH
45211-1106
US

IV. Provider business mailing address

3301 MERCY HEALTH BLVD STE 125
CINCINNATI OH
45211-1106
US

V. Phone/Fax

Practice location:
  • Phone: 513-215-9200
  • Fax: 513-215-9259
Mailing address:
  • Phone: 513-215-9200
  • Fax: 513-215-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD-48120
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53481
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53481
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: