Provider Demographics
NPI:1174513733
Name:EGNACZYK, GREGORY FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:FRANCIS
Last Name:EGNACZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND, FLOOR, CBO2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-206-1180
Mailing Address - Fax:513-206-1182
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 137
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-206-1180
Practice Address - Fax:513-206-1182
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2020-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35096425207RA0001X
OH35.096425207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3188978Medicaid
IN201192860Medicaid
NC5905600Medicaid
KY7100260120Medicaid
KY7100260120Medicaid
OH4308381Medicare PIN