Healthcare Provider Details

I. General information

NPI: 1629060132
Provider Name (Legal Business Name): JOEL D PRANIKOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE 528
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

4685 FOREST AVE STE C
CINCINNATI OH
45212-3359
US

V. Phone/Fax

Practice location:
  • Phone: 513-792-5800
  • Fax: 513-792-5806
Mailing address:
  • Phone: 513-853-4749
  • Fax: 513-853-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35059105
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: