Healthcare Provider Details

I. General information

NPI: 1669692687
Provider Name (Legal Business Name): PRIMARY CARE OF CINCINNATI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 EAST UNIVERSITY AVENUE
CINCINNATI OH
45219-2431
US

IV. Provider business mailing address

318 EAST UNIVERSITY AVENUE
CINCINNATI OH
45219-2431
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-1100
  • Fax: 513-961-7156
Mailing address:
  • Phone: 513-961-1100
  • Fax: 513-961-7156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35049726
License Number StateOH

VIII. Authorized Official

Name: ABRAHAM O OSINBOWALE
Title or Position: PRESIDENT
Credential: MD
Phone: 513-961-1100