Provider Demographics
NPI:1417193681
Name:WOUND SPECIALISTS OF GREATER CINCINNATI, PLLC
Entity Type:Organization
Organization Name:WOUND SPECIALISTS OF GREATER CINCINNATI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTI
Authorized Official - Middle Name:BALAR
Authorized Official - Last Name:MASTURZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-557-3330
Mailing Address - Street 1:PO BOX 643911
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3911
Mailing Address - Country:US
Mailing Address - Phone:513-557-3330
Mailing Address - Fax:513-557-3329
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-865-1111
Practice Address - Fax:513-557-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207PE0005X, 363A00000X, 363L00000X
OH35-082412207R00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64096233Medicaid
OH2993891Medicaid
KY7100118600Medicaid
KY00916Medicare PIN
OH2993891Medicaid
OHP00697409Medicare PIN
KYDP1615Medicare PIN
OHDO6613Medicare PIN
OHI23307Medicare UPIN
KY7100118600Medicaid
OH9380742Medicare PIN