Healthcare Provider Details

I. General information

NPI: 1205090347
Provider Name (Legal Business Name): OHIO PHLEBOLOGY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8044 MONTGOMERY RD SUITE 525
CINCINNATI OH
45236-2919
US

IV. Provider business mailing address

8044 MONTGOMERY RD STE 525
CINCINNATI OH
45236-2925
US

V. Phone/Fax

Practice location:
  • Phone: 630-725-2768
  • Fax:
Mailing address:
  • Phone: 513-793-7999
  • Fax: 513-802-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: TARA BLAND
Title or Position: MANAGER
Credential:
Phone: 513-793-7999