Healthcare Provider Details

I. General information

NPI: 1669719993
Provider Name (Legal Business Name): MIRKO ANGELO BABANI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 STATE RD
CINCINNATI OH
45255-2439
US

IV. Provider business mailing address

20 MEDICAL VILLAGE DR STE 258
EDGEWOOD KY
41017-5401
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-7246
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.14186-NA
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number342566
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: