Provider Demographics
NPI:1043657489
Name:HAROLD T. PRETORIUS, M.D.
Entity Type:Organization
Organization Name:HAROLD T. PRETORIUS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:T
Authorized Official - Last Name:PRETORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-561-3797
Mailing Address - Street 1:4743 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2432
Mailing Address - Country:US
Mailing Address - Phone:513-561-3797
Mailing Address - Fax:513-561-4043
Practice Address - Street 1:103 LANDMARK DR
Practice Address - Street 2:SUITE 365
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1393
Practice Address - Country:US
Practice Address - Phone:513-561-3797
Practice Address - Fax:513-561-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31919207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31919OtherMEDICAL LICENSE