Basic Information
Provider Information
NPI: 1679577365
EntityType: 2
ReplacementNPI:  
OrganizationName: REHABILITATION ELECTRODIAGNOSTIC MEDICINE INC
LastName:  
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Mailing Information
Address1: PO BOX 42461
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452420461
CountryCode: US
TelephoneNumber: 5139658041
FaxNumber: 5139658091
Practice Location
Address1: 6200 PFEIFFER RD
Address2: 3RD FLOOR
City: CINCINNATI
State: OH
PostalCode: 452425862
CountryCode: US
TelephoneNumber: 5139856793
FaxNumber: 5139658091
Other Information
ProviderEnumerationDate: 06/09/2005
LastUpdateDate: 02/25/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: WALSH
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 5139856793
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X  Y193400000X SINGLE SPECIALTY GROUPOther Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
083358505OH MEDICAID
6592326005KY MEDICAID


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