Provider Demographics
NPI:1770146946
Name:GAISER MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:GAISER MANAGEMENT GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GAISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-686-5446
Mailing Address - Street 1:4004 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4627
Mailing Address - Country:US
Mailing Address - Phone:513-635-7622
Mailing Address - Fax:
Practice Address - Street 1:4004 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4627
Practice Address - Country:US
Practice Address - Phone:513-635-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188100Medicaid