MEDICARE: PRIMARY CARE OF CINCINNATI 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	208000000X	Pediatrics Physician	35049726	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

General Provider Information

NPI Number	:	1669692687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE OF CINCINNATI INC

Provider Business Mailing Address
First Line	:	318 EAST UNIVERSITY AVENUE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2431
Country	:	US
Telephone Number	:	513-961-1100
Fax Number	:	513-961-7156

Provider Business Practice Location Address
First Line	:	318 EAST UNIVERSITY AVENUE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2431
Country	:	US
Telephone Number	:	513-961-1100
Fax Number	:	513-961-7156

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABRAHAM O OSINBOWALE
Credential	:	MD
Telephone Number	:	513-961-1100

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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