Healthcare Provider Details

I. General information

NPI: 1366848285
Provider Name (Legal Business Name): COMPREHENSIVE PAIN SPECIALISTS OF CINCINNATI, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 FERGUSON DR SUITE 270
CINCINNATI OH
45245-5136
US

IV. Provider business mailing address

4355 FERGUSON DR SUITE 270
CINCINNATI OH
45245-5136
US

V. Phone/Fax

Practice location:
  • Phone: 513-718-0115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER KROLL
Title or Position: DIRECTOR
Credential: MD
Phone: 615-550-7176