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990 Belvedere Dr Ste A Lebanon OH 45036-2890 | |
| (513) 228-1666 | |
| (513) 228-1555 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 990 Belvedere Dr Ste A, Lebanon, Ohio |
| Authorized Official Name and Position | Madhumathi Kosaraju (PRESIDENT) |
| Authorized Official Contact | 5132281666 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7661 Brookfarm Ct Mason OH 45040-7027 Ph: (513) 398-7376 | 990 Belvedere Dr Ste A Lebanon OH 45036-2890 Ph: (513) 228-1666 |
| NPI Number | 1295717601 |
|---|---|
| Provider Enumeration Date | 11/20/2005 |
| Last Update Date | 05/12/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295717601 | NPI | - | NPPES |
| P00219908 | Other | OH | RAILROAD MEDICARE |
| 2545857 | Medicaid | OH | |
| 378156491001 | Other | OH | MEDICAL MUTUAL OF OHIO |
| 378156495-00 | Other | OH | OHIO BWC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 207R00000X (Ohio) | Primary |
Broadway Family Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1470 N Broadway St, Suite100, Lebanon, OH 45036 Phone: 513-932-1936 Fax: 513-932-3105 | |
Trihealth Physician Practices, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Arrow Springs Blvd, Suite 2800, Lebanon, OH 45036 Phone: 513-282-7300 Fax: 513-282-7310 | |
Primary Care Partners Of Ohio Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 726 E Main St Ste F205, Lebanon, OH 45036 Phone: 513-325-4392 Fax: 513-409-5086 | |