Healthcare Provider Details

I. General information

NPI: 1619887437
Provider Name (Legal Business Name): FARKHOD ALTIBAEV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 ARBOR MONTGOMERY LN
CINCINNATI OH
45249-8015
US

IV. Provider business mailing address

9925 ARBOR MONTGOMERY LN
CINCINNATI OH
45249-8015
US

V. Phone/Fax

Practice location:
  • Phone: 513-656-4468
  • Fax:
Mailing address:
  • Phone: 513-656-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: