Provider Demographics
NPI:1922198613
Name:SAREMBOCK, IAN J (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:J
Last Name:SAREMBOCK
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 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO 2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-985-0022
Mailing Address - Fax:513-985-0088
Practice Address - Street 1:11140 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2309
Practice Address - Country:US
Practice Address - Phone:513-792-7800
Practice Address - Fax:513-792-7807
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089430207RC0000X
OH35.089430207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0301819Medicaid
OH000000513028OtherANTHEM
VA006032311Medicaid
OHP00393051OtherRAILROAD MEDICARE
OH325060OtherAMERIGROUP
OHSA4204341Medicare PIN
OH000000513028OtherANTHEM
OH4204342Medicare PIN
OHP00393051OtherRAILROAD MEDICARE