Healthcare Provider Details

I. General information

NPI: 1154475705
Provider Name (Legal Business Name): CHAD BRANDON UNGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8099 CORNELL RD
CINCINNATI OH
45249-2231
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-3933
  • Fax: 513-793-8299
Mailing address:
  • Phone: 513-354-7650
  • Fax: 513-354-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001102
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: