Healthcare Provider Details

I. General information

NPI: 1063530277
Provider Name (Legal Business Name): JONATHAN RUSSELL DILLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST RADIOLOGY
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

3333 BURNET AVE 5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-2146
  • Fax: 513-584-0431
Mailing address:
  • Phone: 513-636-4225
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number48745
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35 125930
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35 125930
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: