Basic Information
| Provider Information | |||||||||
| NPI: | 1023001823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROSS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636324 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593014000 | ||||||||
| FaxNumber: | 8593014001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2960 MACK RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450145374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137512273 | ||||||||
| FaxNumber: | 5137511840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 35054699 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 01038729A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 25049 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0664062 | 05 | OH | MEDICAID | 200070440 | 05 | IN | MEDICAID | 300119721 | 01 | OH | MEDICARE RAILROAD | OTHER | 64788904 | 05 | KY | MEDICAID | 300119754 | 01 | IN | MEDICARE RAILROAD | OTHER | 900003565 | 01 | KY | MEDICARRE RAILROAD | OTHER |