Individual
DR. MICHAEL T ARCHDEACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
222 PIEDMONT AVE, SUITE 2200, CINCINNATI, OH 45219-4231
(513) 475-8690
(513) 475-7243
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-0001
(513) 585-5506
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
35069283A
OH
207XX0801X
Orthopaedic Trauma Physician
35069283A
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200041359
RAILROAD MEDICARE
OH
05
—
200321580
—
IN
05
—
2246920
—
OH
05
—
64035629
—
KY
Enumeration date
05/05/2006
Last updated
11/22/2017
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