Provider Demographics
NPI:1497842124
Name:BRETT COLDIRON MD
Entity Type:Organization
Organization Name:BRETT COLDIRON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLDIRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-221-2828
Mailing Address - Street 1:200 NORTHLAND BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3604
Mailing Address - Country:US
Mailing Address - Phone:513-672-4128
Mailing Address - Fax:513-672-4479
Practice Address - Street 1:3024 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2420
Practice Address - Country:US
Practice Address - Phone:513-221-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-049740207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64869621Medicaid
OH0566847Medicaid
OH0566847Medicaid