Provider Demographics
NPI:1619901840
Name:PRETORIUS AND ROBLES M.D.'S
Entity Type:Organization
Organization Name:PRETORIUS AND ROBLES M.D.'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PRETORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:513-561-3797
Mailing Address - Street 1:4743 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2432
Mailing Address - Country:US
Mailing Address - Phone:513-561-3797
Mailing Address - Fax:
Practice Address - Street 1:4743 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2432
Practice Address - Country:US
Practice Address - Phone:513-561-3797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.056690207R00000X, 207RE0101X, 207UN0902X
KY31919207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0586094Medicaid
OH31-1180985OtherTAX ID # DR. ALAM
OH22000000013351OtherANTHEMBLUECROSSBLUESHIELD
KY64-869316Medicaid
OH167090543703OtherHUMANA
OHP2309187OtherOXFORD
OH1137929OtherWORKER'S COMPENSATION
OH56690OtherCHOICECARE
KY000000013351OtherANTHEMHEALTHPLANSKENTUCKY
1205826732OtherNPI PROVIDER NUMBER DR. ALAM
OH4100195OtherAETNA
OH0764589Medicaid
OH110069666OtherRAILROAD MEDICARE
OH56690OtherHMNANA/CHOICECARE
OH56690OtherHMNANA/CHOICECARE
OH0764589Medicaid
OH4100195OtherAETNA
OH110069666Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH=========026Medicaid
OH0565562Medicare PIN
KY000000013351OtherANTHEMHEALTHPLANSKENTUCKY
OHA16018Medicare UPIN