Healthcare Provider Details

I. General information

NPI: 1629168109
Provider Name (Legal Business Name): ELIAS ANAISSIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219
US

IV. Provider business mailing address

2830 VICTORY PARKWAY
CINCINNATI OH
45206
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8500
  • Fax: 513-584-8554
Mailing address:
  • Phone: 513-584-8500
  • Fax: 513-584-8554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE-1221
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35.120160
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberE-1221
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: