Healthcare Provider Details

I. General information

NPI: 1902899214
Provider Name (Legal Business Name): JOHN A BISMAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 5 MILE RD #100
CINCINNATI OH
45230-2163
US

IV. Provider business mailing address

5053 WOOSTER RD
CINCINNATI OH
45226-2326
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-2273
  • Fax: 513-751-1840
Mailing address:
  • Phone: 513-751-2145
  • Fax: 513-751-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35036544
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number19916
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01026470A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: