Healthcare Provider Details

I. General information

NPI: 1306845151
Provider Name (Legal Business Name): PAUL JOSEPH FAVORITO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 RED BANK EXPRESSWAY
CINCINNATI OH
45227
US

IV. Provider business mailing address

4460 RED BANK EXPRESSWAY
CINCINNATI OH
45227-2172
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5200
  • Fax: 513-791-5229
Mailing address:
  • Phone: 513-791-5200
  • Fax: 513-791-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35075562
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: