Healthcare Provider Details

I. General information

NPI: 1417903469
Provider Name (Legal Business Name): EDMOND G SIFRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5914 GLENWAY AVE
CINCINNATI OH
45238-2009
US

IV. Provider business mailing address

4692 MISSION LN
CINCINNATI OH
45223-1263
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-4271
  • Fax: 513-922-3936
Mailing address:
  • Phone: 513-541-9051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number35031192
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: