Healthcare Provider Details

I. General information

NPI: 1942206073
Provider Name (Legal Business Name): PAUL J. CANGEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

10 N LOCUST ST STE 1B
OXFORD OH
45056-1182
US

IV. Provider business mailing address

174 STONE CREEK DR
OXFORD OH
45056-9758
US

V. Phone/Fax

Practice location:
  • Phone: 513-524-1100
  • Fax: 513-524-0085
Mailing address:
  • Phone: 513-523-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number35-036511
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: