Individual
DR. BRUCE LYLE TETIRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9312 WINTON RD, CINCINNATI, OH 45231-3938
(513) 922-0009
(513) 931-2481
Mailing address
2060 READING RD, SUITE 150, CINCINNATI, OH 45202-1454
(513) 721-3200
(513) 639-3186
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
35042511
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000021056
ANTHEM
OH
05
—
0580625
—
OH
01
—
288089
AMERIGROUP
OH
01
—
31157505137
CARESOURCE
OH
01
—
720619
UNITED HEALTHCARE
OH
01
—
990127
AETNA
OH
01
—
P00149781
MEDICARE RAILROAD
OH
Enumeration date
05/31/2005
Last updated
07/31/2015
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