Healthcare Provider Details

I. General information

NPI: 1134419005
Provider Name (Legal Business Name): ANIS A ANSARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE ML 5037
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVENUE ML 5037
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4975
  • Fax: 513-636-6753
Mailing address:
  • Phone: 513-636-4975
  • Fax: 513-636-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: