Healthcare Provider Details

I. General information

NPI: 1184400939
Provider Name (Legal Business Name): GALIYA RAISIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 03/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE DIVISION OF UROLOGY, MLC 5037
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE DIVISION OF UROLOGY, MLC 5037
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-3736
  • Fax:
Mailing address:
  • Phone: 513-252-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number57.254070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: