Provider Demographics
NPI:1760431159
Name:PRETORIUS, HAROLD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:THOMAS
Last Name:PRETORIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:513-561-4043
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:513-561-4043
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 . 056690207RE0101X, 207UN0902X
KY31919207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9252401OtherMEDICARE PROVIDER ID#
OH000000014674OtherANTHEM
OH4100195OtherAETNA
OH0764589Medicaid
OH56690OtherCHOICECARE
OH1137929OtherWORKERS COMPENSATION
OH56690OtherHUMANA
KY64-869316Medicaid
OH56690OtherHUMANA
KY64-869316Medicaid
OHPR0657423Medicare PIN