Provider Demographics
NPI:1609206283
Name:GYNECOLOGIC & OBSTETRIC CONSULTANTS OF GREATER CINCINNATI
Entity Type:Organization
Organization Name:GYNECOLOGIC & OBSTETRIC CONSULTANTS OF GREATER CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PRANIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-792-5800
Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:#528
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-792-5800
Mailing Address - Fax:513-792-5806
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:#528
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-792-5800
Practice Address - Fax:513-792-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-059105174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821721Medicaid
OH0821721Medicaid