Provider Demographics
NPI:1942565841
Name:WATANABE TEJADA, LUIS CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:CARLOS
Last Name:WATANABE TEJADA
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 1:4760 E GALBRAITH RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6704
Mailing Address - Country:US
Mailing Address - Phone:513-791-4490
Mailing Address - Fax:513-791-7287
Practice Address - Street 1:4760 E GALBRAITH RD STE 206
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6704
Practice Address - Country:US
Practice Address - Phone:513-791-4490
Practice Address - Fax:513-791-7287
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.149489207R00000X
MI4301101057207R00000X
IL036138396207RP1001X
KY51618207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease