Healthcare Provider Details

I. General information

NPI: 1447588009
Provider Name (Legal Business Name): BENJAMIN L STIVERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E GALBRAITH RD DEPT. OF SURGERY
CINCINNATI OH
45236-2725
US

IV. Provider business mailing address

4777 E. GALBRAITH ROAD DEPT. OF SURGERY
CINCINNATI OH
45236
US

V. Phone/Fax

Practice location:
  • Phone: 513-686-5466
  • Fax: 513-686-5469
Mailing address:
  • Phone: 513-686-5466
  • Fax: 513-686-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57.017037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: