Healthcare Provider Details

I. General information

NPI: 1902866015
Provider Name (Legal Business Name): THOMAS J HOLUBECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 WINNESTE AVE
CINCINNATI OH
45232-1130
US

IV. Provider business mailing address

5275 WINNESTE AVE
CINCINNATI OH
45232-1130
US

V. Phone/Fax

Practice location:
  • Phone: 513-242-1033
  • Fax: 513-242-1539
Mailing address:
  • Phone: 513-242-1033
  • Fax: 513-242-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35070908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: