Healthcare Provider Details

I. General information

NPI: 1831248905
Provider Name (Legal Business Name): CHAD JEREME FOGT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 ROSS MILLVILLE RD SUITE B50
HAMILTON OH
45013-8951
US

IV. Provider business mailing address

2449 ROSS MILLVILLE RD STE B50
HAMILTON OH
45013-8952
US

V. Phone/Fax

Practice location:
  • Phone: 513-737-6068
  • Fax: 513-737-6681
Mailing address:
  • Phone: 937-752-2306
  • Fax: 937-522-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008667
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: