Individual
CARL JACK FICHTENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 ALBERT SABIN WAY, # 405, CINCINNATI, OH 45267-2800
(513) 584-6977
(513) 584-6040
Mailing address
2830 VICTORY PKWY, STE 310, CINCINNATI, OH 45206-3700
(513) 245-3444
(513) 245-3449
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35-076757
OH
207RI0200X
Infectious Disease Physician
Primary
35-076757
OH
208000000X
Pediatrics Physician
35-076757
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010064796
RAIL ROAD MEDICARE
OH
05
—
200252570
—
IN
05
—
2147484
—
OH
05
—
64005580
—
KY
Enumeration date
04/20/2006
Last updated
03/27/2014
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