Individual
WAI TAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3188 BELLEVUE AVE, CINCINNATI, OH 45219-2369
(513) 475-8521
(513) 475-7480
Mailing address
PO BOX 636256, CINCINNATI, OH 45263-6256
(513) 585-6200
(513) 245-3672
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
34.015031
OH
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
34.015031
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/02/2015
Last updated
05/14/2024
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