Healthcare Provider Details

I. General information

NPI: 1407484371
Provider Name (Legal Business Name): DIANE FRU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

231 ALBERT SABIN WAY
CINCINNATI OH
45267-0769
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-5239
  • Fax: 513-584-2579
Mailing address:
  • Phone: 513-338-7651
  • Fax: 513-558-7622

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: