MEDICARE: MICHAEL D PRIVITERA 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	2084E0001X	Epilepsy Physician	35054494	OH
2	2084N0400X	Neurology Physician	35054494	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130010777	OTHER	OH	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1629005814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D PRIVITERA MD

Provider Business Mailing Address
First Line	:	PO BOX 636256 CENTRAL CREDENTIALING
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	513-585-5504
Fax Number	:	513-585-5511

Provider Business Practice Location Address
First Line	:	3113 BELLEVUE AVE FL 3
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-3158
Country	:	US
Telephone Number	:	513-652-6500
Fax Number	:	513-475-8033

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	09/25/2024

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Directions to “ MICHAEL D PRIVITERA MD” Practice Location

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