Provider Demographics
NPI:1982787768
Name:MINEVICH, EUGENE A (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:MINEVICH
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 1:3333 BURNET AVE
Mailing Address - Street 2:ML 5037
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4975
Mailing Address - Fax:513-636-6753
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 5037
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4975
Practice Address - Fax:513-636-6753
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0657082088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMI7262991Medicare ID - Type Unspecified