MEDICARE: BRETT COLDIRON MD

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	207N00000X	Dermatology Physician	35-049740	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497842124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRETT COLDIRON MD

Provider Business Mailing Address
First Line	:	200 NORTHLAND BLVD FL 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3604
Country	:	US
Telephone Number	:	513-672-4128
Fax Number	:	513-672-4479

Provider Business Practice Location Address
First Line	:	3024 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2420
Country	:	US
Telephone Number	:	513-221-2828
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRETT COLDIRON
Credential	:	MD
Telephone Number	:	513-221-2828

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	09/12/2007

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