Healthcare Provider Details

I. General information

NPI: 1487823639
Provider Name (Legal Business Name): MARK MAKUMBI KAYANJA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

PO BOX 636256
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8690
  • Fax: 513-475-7593
Mailing address:
  • Phone: 513-585-6200
  • Fax: 513-245-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.096780
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberR7782
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: