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General NPI Number Information
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NPI Number | 1699723247
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Entity Type | Individual
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Provider Name | MICHAEL T ARCHDEACON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 222 PIEDMONT AVE SUITE 2200
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City | CINCINNATI
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State | OH
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Zip | 45219-4231
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Country | US
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Telephone | 513-475-8690
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Fax | 513-475-7243
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Provider Business Mailing Address
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Address Line | PO BOX 636256 CENTRAL CREDENTIALING
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City | CINCINNATI
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State | OH
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Zip | 45263-0001
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Country | US
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Telephone | 513-585-5506
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Fax | 513-585-5511
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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 | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 35069283A
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 35069283A
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License Number State | OH
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