Healthcare Provider Details

I. General information

NPI: 1669260626
Provider Name (Legal Business Name): MUHAMMAD IMTANAN FAZAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E. GALBRIATH ROAD JEWISH HOSPITAL OF CINCINNATI
CINCINNATI OH
45236
US

IV. Provider business mailing address

4777 E. GALBRIATH ROAD JEWISH HOSPITAL OF CINCINNATI
CINCINNATI OH
45236
US

V. Phone/Fax

Practice location:
  • Phone: 513-686-5446
  • Fax: 513-686-6868
Mailing address:
  • Phone: 513-686-5446
  • Fax: 513-686-6868

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: