Provider Demographics
| NPI: | 1174729438 |
|---|---|
| Name: | MAX, JOSHUA B (MD) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | JOSHUA |
| Middle Name: | B |
| Last Name: | MAX |
| Suffix: | |
| Gender: | M |
| Credentials: | MD |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 10600 MONTGOMERY RD |
| Mailing Address - Street 2: | STE 200 |
| Mailing Address - City: | CINCINNATI |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45242-4463 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 513-794-5600 |
| Mailing Address - Fax: | 513-281-1908 |
| Practice Address - Street 1: | 10600 MONTGOMERY RD |
| Practice Address - Street 2: | STE 200 |
| Practice Address - City: | CINCINNATI |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45242-4463 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 513-794-5600 |
| Practice Address - Fax: | 513-281-1908 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2007-06-25 |
| Last Update Date: | 2024-04-18 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MN | 50909 | 207R00000X |
| OH | 35.124087 | 207RG0100X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 0106603 | Medicaid | |
| IN | IN1395025 | Medicare PIN | |
| OH | H338920 | Medicare PIN |