Provider Demographics
NPI:1497066526
Name:MARZEC, ALISA J (MD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:J
Last Name:MARZEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6930
Mailing Address - Country:US
Mailing Address - Phone:513-981-5123
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:100 PROGRESSIVE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830
Practice Address - Country:US
Practice Address - Phone:419-659-6010
Practice Address - Fax:419-659-6012
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY45310207Q00000X
OH35.123364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100177560Medicaid
KYP01335359OtherRAILROAD MEDICARE
KY7100177560Medicaid
KYK012941Medicare PIN
KYK012940Medicare PIN
KYK012942Medicare PIN