Healthcare Provider Details

I. General information

NPI: 1063402949
Provider Name (Legal Business Name): HENRY ALBERT STIENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 HARRISON AVE SUITE 201
CINCINNATI OH
45247-7961
US

IV. Provider business mailing address

500 E-BUSINESS WAY SUITE A
CINCINNATI OH
45241-6014
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-3700
  • Fax: 513-354-7651
Mailing address:
  • Phone: 513-354-3700
  • Fax: 513-354-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number35-05-5433
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: