Provider Demographics
NPI:1609842087
Name:UNIVERSITY FAMILY PHYSICIANS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY FAMILY PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-558-4021
Mailing Address - Street 1:141 HEALTH PROFESSIONS BUILDING
Mailing Address - Street 2:PO BOX 670582
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0582
Mailing Address - Country:US
Mailing Address - Phone:513-558-4021
Mailing Address - Fax:513-558-3030
Practice Address - Street 1:141 HEALTH PROFESSIONS BUILDING
Practice Address - Street 2:ML 0582
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0582
Practice Address - Country:US
Practice Address - Phone:513-558-4021
Practice Address - Fax:513-558-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2102914Medicaid
OH9196403Medicare ID - Type UnspecifiedMEDICARE GROUP PRACTICE