Healthcare Provider Details

I. General information

NPI: 1003871575
Provider Name (Legal Business Name): PAUL J GUBANICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4366
  • Fax: 513-636-0516
Mailing address:
  • Phone: 513-636-4366
  • Fax: 513-636-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number35.084806
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: