Provider Demographics
NPI:1013062710
Name:PAUL MD LLC
Entity Type:Organization
Organization Name:PAUL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAWEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SZCZYKUTOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-793-1580
Mailing Address - Street 1:PO BOX 643450
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0308
Mailing Address - Country:US
Mailing Address - Phone:513-325-4625
Mailing Address - Fax:513-777-4693
Practice Address - Street 1:7300 SUSAN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4082
Practice Address - Country:US
Practice Address - Phone:513-325-4625
Practice Address - Fax:513-777-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDC6890OtherRR MEDICARE
OH2948538Medicaid
OHDC6890OtherRR MEDICARE