Healthcare Provider Details

I. General information

NPI: 1730350299
Provider Name (Legal Business Name): MICHAEL WOLUJEWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

PO BOX 42456
CINCINNATI OH
45242-0456
US

V. Phone/Fax

Practice location:
  • Phone: 513-962-2611
  • Fax: 513-965-8091
Mailing address:
  • Phone: 513-247-8646
  • Fax: 513-965-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35120626
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number46336
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: