Provider Demographics
NPI:1326200205
Name:YOUR MD, LLC
Entity Type:Organization
Organization Name:YOUR MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CORSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-721-9600
Mailing Address - Street 1:PO BOX 633883
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3883
Mailing Address - Country:US
Mailing Address - Phone:513-721-9600
Mailing Address - Fax:513-721-1649
Practice Address - Street 1:8250 KENWOOD CROSSING WAY
Practice Address - Street 2:SUITE 225
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3670
Practice Address - Country:US
Practice Address - Phone:513-721-9600
Practice Address - Fax:513-721-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9341041Medicare PIN