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General NPI Number Information
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NPI Number | 1144390345
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Entity Type | Organization
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Legal Business Name | MONTGOMERY FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 10550 MONTGOMERY RD STE 11
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City | MONTGOMERY
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State | OH
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Zip | 45242-4495
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Country | US
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Telephone | 513-791-1201
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Fax | 513-791-1231
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Provider Business Mailing Address
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Address Line | 10550 MONTGOMERY RD # 12
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City | CINCINNATI
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State | OH
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Zip | 45242
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Country | US
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Telephone | 513-791-1201
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Fax | 513-791-1231
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Authorized Official
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Title or Position | PRESIDENT MD
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Name | DR. GINGER S KUBALA
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Credential | MD
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Telephone | 513-791-1201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35057045
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35067638
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 350728718
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License Number State | OH
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