=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730940669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZERBE & SUGARMAN INTERNAL MEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2024
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5400 KENNEDY AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45213-2664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-458-3685
-----------------------------------------------------
Fax | 513-924-5472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 KENNEDY AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45213-2664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-458-3685
-----------------------------------------------------
Fax | 513-924-5472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | NICOLE M EGBERS
-----------------------------------------------------
Credential | CMA
-----------------------------------------------------
Telephone | 513-458-3685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------