Provider Demographics
NPI:1669443529
Name:LUM, TED M (MD INC)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:M
Last Name:LUM
Suffix:
Gender:M
Credentials:MD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 BURNET AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2426
Mailing Address - Country:US
Mailing Address - Phone:513-221-6300
Mailing Address - Fax:513-221-6302
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2426
Practice Address - Country:US
Practice Address - Phone:513-221-6300
Practice Address - Fax:513-221-6302
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050266L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561383Medicare PIN
OHA81782Medicare UPIN