Basic Information
Provider Information | |||||||||
NPI: | 1922092287 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SIGMUND | ||||||||
FirstName: | DUANE | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5053 WOOSTER RD | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452262326 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5137512145 | ||||||||
FaxNumber: | 5137512138 | ||||||||
Practice Location | |||||||||
Address1: | 4725 E GALBRAITH RD | ||||||||
Address2: | # 320 | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452362796 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5137512273 | ||||||||
FaxNumber: | 5137936290 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/01/2005 | ||||||||
LastUpdateDate: | 05/12/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 35047767 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | 33579 | KY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
ID | Type | State | Issuer | Description | 200036320 | 05 | IN |   | MEDICAID | 64785686 | 05 | KY |   | MEDICAID | 0615561 | 05 | OH |   | MEDICAID |