Healthcare Provider Details

I. General information

NPI: 1336670363
Provider Name (Legal Business Name): LUIS F ACOSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE, ML 5031
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE, ML 5031
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4251
  • Fax: 513-636-8145
Mailing address:
  • Phone: 513-636-4251
  • Fax: 513-636-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35.156401
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR5450
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberIP1567
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number56735
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: