MEDICARE: GLOW MEDISPA, LLC

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	2083B0002X	Obesity Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1699575407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOW MEDISPA, LLC

Provider Business Mailing Address
First Line	:	8833 CHAPELSQUARE DR STE C
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-4706
Country	:	US
Telephone Number	:	513-826-6142
Fax Number	:	346-636-5775

Provider Business Practice Location Address
First Line	:	8833 CHAPELSQUARE DR STE C
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-4706
Country	:	US
Telephone Number	:	513-826-6142
Fax Number	:	346-636-5775

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RODERICK MATTHEW HUFF
Credential	:	MD
Telephone Number	:	513-405-4462

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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Directions to “GLOW MEDISPA, LLC ” Practice Location

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