MEDICARE: JESUS C HONTANOSAS 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	208600000X	Surgery Physician	35043368OH	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000010212	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639139017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESUS C HONTANOSAS MD INC

Provider Business Mailing Address
First Line	:	2055 HOSPITAL DR
Second Line	:	STE 335
City	:	BATAVIA
State	:	OH
Zip	:	45103-1978
Country	:	US
Telephone Number	:	513-732-1660
Fax Number	:	513-732-1665

Provider Business Practice Location Address
First Line	:	2055 HOSPITAL DR
Second Line	:	STE 335
City	:	BATAVIA
State	:	OH
Zip	:	45103-1978
Country	:	US
Telephone Number	:	513-732-1660
Fax Number	:	513-732-1665

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESUS C HONTANOSAS
Credential	:	MD
Telephone Number	:	513-732-1660

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/01/2009

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