Basic Information
| Provider Information | |||||||||
| NPI: | 1891743076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEESNER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ELIOT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 VICTORY PKWY | ||||||||
| Address2: | STE 310 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452063700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453444 | ||||||||
| FaxNumber: | 5132453449 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 PIEDMONT AVE | ||||||||
| Address2: | STE 6000 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452194231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134757505 | ||||||||
| FaxNumber: | 5134757355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 12/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-037250 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 35-037250 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 100016547 | 01 | OH | RAIL ROAD MEDICARE | OTHER | 64864853 | 05 | KY | MEDICAID | 200218170 | 05 | IN | MEDICAID | 0515688 | 05 | OH | MEDICAID |