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NPI Code Detail

MEDICARE: TED M LUM MD INC

MEDICARE: TED M LUM 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
1174400000XSpecialist35050266LOH

General Provider Information

NPI Number : 1669443529
Entity Type Code : Individual
Provider Name (Legal Business Name) : TED M LUM MD INC
Provider Business Mailing Address
First Line : 2825 BURNET AVE
Second Line : SUITE 208
City : CINCINNATI
State : OH
Zip : 45219-2426
Country : US
Telephone Number : 513-221-6300
Fax Number : 513-221-6302
Provider Business Practice Location Address
First Line : 2825 BURNET AVE
Second Line : SUITE 208
City : CINCINNATI
State : OH
Zip : 45219-2426
Country : US
Telephone Number : 513-221-6300
Fax Number : 513-221-6302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 12/17/2007

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