Healthcare Provider Details

I. General information

NPI: 1275532327
Provider Name (Legal Business Name): ROBERT SAMUEL HEIDT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

IV. Provider business mailing address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-6677
  • Fax: 513-232-2522
Mailing address:
  • Phone: 513-232-6677
  • Fax: 513-232-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35041019
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.041019
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: