Provider Demographics
NPI:1750684197
Name:MD2U OHIO LLC
Entity type:Organization
Organization Name:MD2U OHIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-416-1851
Mailing Address - Street 1:PO BOX 7219
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-0219
Mailing Address - Country:US
Mailing Address - Phone:502-416-1851
Mailing Address - Fax:502-416-1857
Practice Address - Street 1:8044 MONTGOMERY RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2919
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:502-618-4990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD2U MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-07
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9392961Medicare PIN