Healthcare Provider Details

I. General information

NPI: 1194874149
Provider Name (Legal Business Name): JON E MENDELSOHN MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 EDWARDS RD SUITE 100
CINCINNATI OH
45209-1900
US

IV. Provider business mailing address

3805 EDWARDS RD SUITE 100
CINCINNATI OH
45209-1900
US

V. Phone/Fax

Practice location:
  • Phone: 513-351-3223
  • Fax: 513-396-8995
Mailing address:
  • Phone: 513-351-3223
  • Fax: 513-396-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number35071983
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: