Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 57130 | TN |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 35.136074 | OH |
NPI | 1710327358 |
---|---|
Provider Name | Brian Cervenka |
First Address | Cincinnati, OH 45206-1785 |
Second Address | Cincinnati, OH 45219-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 06/05/2019 |