MEDICARE: GAISER MANAGEMENT GROUP 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1770146946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAISER MANAGEMENT GROUP LLC

Provider Business Mailing Address
First Line	:	4004 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-4627
Country	:	US
Telephone Number	:	513-635-7622
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-4627
Country	:	US
Telephone Number	:	513-635-7622
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CORY ALLEN GAISER
Credential	:	MD
Telephone Number	:	513-686-5446

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	09/06/2020

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