Healthcare Provider Details

I. General information

NPI: 1396952099
Provider Name (Legal Business Name): INTERNAL MEDICINE AND GERIATRICS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 FAWNRUN DR
CINCINNATI OH
45241-3832
US

IV. Provider business mailing address

PO BOX 635739
CINCINNATI OH
45263-0044
US

V. Phone/Fax

Practice location:
  • Phone: 513-889-9902
  • Fax: 513-793-0729
Mailing address:
  • Phone: 513-889-9902
  • Fax: 513-793-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AUDRIUS RUKSENAS
Title or Position: OWNER
Credential: MD
Phone: 513-722-6037