Healthcare Provider Details

I. General information

NPI: 1669010344
Provider Name (Legal Business Name): BENJAMIN SIEMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

PO BOX 632572
CINCINNATI OH
45263-2572
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-2432
  • Fax: 513-862-8857
Mailing address:
  • Phone: 859-341-2666
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberLE-00030756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: