Organization
ITM GERIATRIC SPECIALIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IMRAN T MINHAS MD (OWNER)
(513) 569-6780
Entity
Organization
Contact information
Practice address
619 OAK ST, RM 645, CINCINNATI, OH 45206-1613
(513) 569-6780
(513) 569-6555
Mailing address
PO BOX 635627, CINCINNATI, OH 45263-0044
(513) 891-7574
(513) 891-1039
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2958983
—
OH
01
—
DF8219
RR MEDICARE
OH
Enumeration date
01/25/2007
Last updated
10/07/2009
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