MEDICARE: JOHN DAVID CORL MD

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	207RC0000X	Cardiovascular Disease Physician	35075272	OH
2	207RC0000X	Cardiovascular Disease Physician	35726	KY
3	207RI0011X	Interventional Cardiology Physician	35.075272	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000526402	OTHER	OH	ANTHEM
4	2504699	OTHER	OH	UNITED

General Provider Information

NPI Number	:	1790778595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID CORL MD

Provider Business Mailing Address
First Line	:	7545 BEECHMONT AVE
Second Line	:	SUITE D
City	:	CINCINNATI
State	:	OH
Zip	:	45255-4205
Country	:	US
Telephone Number	:	513-206-1320
Fax Number	:	513-232-8483

Provider Business Practice Location Address
First Line	:	7545 BEECHMONT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-4222
Country	:	US
Telephone Number	:	513-206-1320
Fax Number	:	513-232-8483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/24/2020

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Directions to “ JOHN DAVID CORL MD” Practice Location

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