=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194525907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINT MED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2025
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8833 CHAPELSQUARE DR STE C
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45249-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-826-6142
-----------------------------------------------------
Fax | 346-636-5775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8833 CHAPELSQUARE DR STE C
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45249-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-826-6142
-----------------------------------------------------
Fax | 346-636-5775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RODERICK MATTHEW HUFF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 513-405-4462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083B0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------