Healthcare Provider Details

I. General information

NPI: 1437099470
Provider Name (Legal Business Name): CHANNING NATANAEL PEZET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

231 ALBERT SABIN WAY PO BOX 670212 MEDICAL SCIENCES BUILDING ROOM 5506
CINCINNATI OH
45267-0212
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: