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General NPI Number Information
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NPI Number | 1659659993
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Entity Type | Individual
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Provider Name | COLLEEN ELIZABETH WIRTZ D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 4777 E GALBRAITH RD
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City | CINCINNATI
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State | OH
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Zip | 45236-2725
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Country | US
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Telephone | 513-686-5093
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20068
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City | CINCINNATI
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State | OH
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Zip | 45220-0068
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Country | US
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Telephone | 614-271-1612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 34.011834
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License Number State | OH
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