Provider Demographics
NPI:1609044015
Name:CASE, JUSTIN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WILLIAM
Last Name:CASE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:ST. ELIZABETH PHYSICIANS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5553
Practice Address - Street 1:4900 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4824
Practice Address - Country:US
Practice Address - Phone:859-212-5200
Practice Address - Fax:859-344-5553
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2012-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY40845207R00000X
OH093161207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3126843Medicaid
KY7100047300Medicaid
KY3385750Medicare Oscar/Certification
KY7100047300Medicaid