MEDICARE: OHIO PHLEBOLOGY PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	208600000X	Surgery Physician	OH
2	2086S0129X	Vascular Surgery Physician	OH
3	2085R0204X	Vascular & Interventional Radiology Physician	OH
4	202K00000X	Phlebology Physician	OH

General Provider Information

NPI Number	:	1205090347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO PHLEBOLOGY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	8044 MONTGOMERY RD STE 525
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2925
Country	:	US
Telephone Number	:	513-793-7999
Fax Number	:	513-802-5054

Provider Business Practice Location Address
First Line	:	8044 MONTGOMERY RD
Second Line	:	SUITE 525
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2919
Country	:	US
Telephone Number	:	630-725-2768
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TARA BLAND
Credential	:
Telephone Number	:	513-793-7999

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	09/04/2025

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Directions to “OHIO PHLEBOLOGY PROFESSIONAL CORPORATION ” Practice Location

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