Provider Demographics
NPI:1881851467
Name:WIRTZ, PATRICK M (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:WIRTZ
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 1:2000 JOSEPH E SANKER BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1979
Mailing Address - Country:US
Mailing Address - Phone:513-841-7400
Mailing Address - Fax:513-841-7402
Practice Address - Street 1:10220 ALLIANCE RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4710
Practice Address - Country:US
Practice Address - Phone:513-841-7800
Practice Address - Fax:513-841-7801
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35097408208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00999912OtherRAILROAD MEDICARE
OHP00999912OtherRAILROAD MEDICARE
OH1114950022Medicare NSC