MEDICARE: MARIANNA VARDAKA MD INC

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	207VG0400X	Gynecology Physician	0833452	OH

General Provider Information

NPI Number	:	1477731784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIANNA VARDAKA MD INC

Provider Business Mailing Address
First Line	:	4760 E GALBRAITH RD
Second Line	:	200
City	:	CINCINNATI
State	:	OH
Zip	:	45236-6703
Country	:	US
Telephone Number	:	513-985-9017
Fax Number	:	513-985-9036

Provider Business Practice Location Address
First Line	:	1087 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-1000
Country	:	US
Telephone Number	:	502-637-4579
Fax Number	:	502-637-4633

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIANNA C VARDAKA
Credential	:	MD
Telephone Number	:	513-985-9017

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	05/07/2008

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