MEDICARE: DR. EDMOND G SIFRI M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0201X	Pediatric Allergy/Immunology Physician	35031192	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417903469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMOND G SIFRI M.D.

Provider Business Mailing Address
First Line	:	4692 MISSION LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-1263
Country	:	US
Telephone Number	:	513-541-9051
Fax Number	:

Provider Business Practice Location Address
First Line	:	5914 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2009
Country	:	US
Telephone Number	:	513-922-4271
Fax Number	:	513-922-3936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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