Active NPI 1912053067 Individual Practitioner Male Practitioner

Dr. Randall P Leduc , MD

Internal Medicine • Aurora, IN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Randall Leduc, MD is a certified Internal Medicine practicing in Aurora, IN. With approximately 37 years of clinical experience since graduating from Wayne State University School Of Medicine in 1989, Dr. Leduc delivers high-quality medical care to the local community at 112 LINKS WAY.

Dr. Leduc is affiliated with Summit Medical Group Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include injection, methylprednisolone acetate, 1 mg, established patient outpatient office visit, injection beneath the skin or into muscle for therapy, diagnosis, or prevention. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

112 Links Way

Aurora, IN 470011403

Telephone 8124968783

Fax 8124323386

Associated Practice Facility / Clinic

🏢 Summit Medical Group, Inc Facility NPI 1548677636

Medicare Profile & Education

Medical School

Wayne State University School Of Medicine

Graduation Year

1989

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Aurora, IN

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

37 Yrs Matches City Avg

City Avg: 37.0 Yrs

State Avg: 26.2 Yrs

Regional Practice Density

1 Specialists

Practicing in Aurora, IN (2204 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

58.8% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Leduc (37 Years) 37 Yrs

Aurora Specialty Average (37.0 Years) 37.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J1010 Injection, methylprednisolone acetate, 1 mg	8,560	88	$0.55	$0.13
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	739	239	$301.00	$121.26
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	412	118	$33.00	$13.59
J1885 Injection, ketorolac tromethamine, per 15 mg	286	29	$2.00	$0.71
99213 Established patient office or other outpatient visit, typically 15 minutes	267	146	$213.00	$86.05
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	239	239	$305.00	$124.53
83036 Hemoglobin A1C level	191	81	$25.00	$9.47
G0008 Administration of influenza virus vaccine	139	136	$101.00	$30.10
90656 Vaccine for influenza for administration into muscle, 0.5 ml dosage	92	92	$47.00	$21.66
36415 Insertion of needle into vein for collection of blood sample	58	47	$22.00	$8.65
90662 Influenza vaccine split virus, preservative free	42	42	$141.00	$81.82
J1030 Injection, methylprednisolone acetate, 40 mg	36	29	$21.00	$6.35
99495 Transitional care management services for problem of at least moderate complexity	31	28	$479.00	$196.62
82044 Urine microalbumin (protein) analysis	29	29	$16.00	$6.11
82570 Creatinine level to test for kidney function or muscle injury	29	29	$13.00	$5.08
90480 Admn sarscov2 vacc 1 dose	26	26	$90.00	$38.59
91320 Sarscv2 vac 30mcg trs-suc im	25	25	$289.00	$140.84
17110 Destruction of up to 14 skin growths	24	17	$260.00	$106.57
80305 Testing for presence of drug, read by direct observation	22	16	$32.00	$12.35
J1040 Injection, methylprednisolone acetate, 80 mg	21	18	$32.00	$9.70
93000 Routine ekg using at least 12 leads including interpretation and report	15	15	$64.00	$13.40
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	13	13	$392.00	$158.69
69209 Removal of impacted ear wax by washing	13	13	$56.54	$19.21
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	11	11	$392.00	$158.49

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	812	255	$180.00	$118.98
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	427	122	$50.00	$13.35
J1885 Injection, ketorolac tromethamine, per 15 mg	336	32	$1.00	$0.53
99213 Established patient office or other outpatient visit, typically 15 minutes	321	158	$135.00	$84.95
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	245	245	$275.00	$122.86
J1030 Injection, methylprednisolone acetate, 40 mg	227	109	$9.00	$7.67
83036 Hemoglobin A1C level	168	85	$23.00	$9.41
G0008 Administration of influenza virus vaccine	164	157	$38.00	$28.63
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	145	139	$33.00	$21.85
82044 Urine microalbumin (protein) analysis	54	51	$12.00	$6.11
36415 Insertion of needle into vein for collection of blood sample	52	38	$16.00	$7.78
17110 Destruction of up to 14 skin growths	30	21	$224.00	$106.53
J1040 Injection, methylprednisolone acetate, 80 mg	30	25	$18.00	$11.42
93000 Routine ekg using at least 12 leads including interpretation and report	24	24	$41.00	$12.95
80305 Testing for presence of drug, read by direct observation	24	13	$85.00	$12.35
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	23	23	$285.00	$157.14
90480 Admn sarscov2 vacc 1 dose	22	22	$90.00	$38.17
91320 Sarscv2 vac 30mcg trs-suc im	22	22	$289.00	$128.48
99495 Transitional care management services for problem of at least moderate complexity	20	16	$345.00	$193.16
G0009 Administration of pneumococcal vaccine	19	19	$38.00	$28.63
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	17	17	$525.00	$282.04
17000 Destruction of skin growth	13	11	$151.00	$63.09
99496 Transitional care management services for problem of high complexity	12	12	$465.00	$225.14
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	11	11	$270.00	$157.46

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	715	222	$176.81	$120.63
99213 Established patient office or other outpatient visit, typically 15 minutes	440	206	$128.82	$85.31
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	395	116	$50.00	$13.43
J1885 Injection, ketorolac tromethamine, per 15 mg	328	32	$1.00	$0.55
83036 Hemoglobin A1C level	254	121	$23.00	$9.56
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	224	224	$269.17	$124.20
J1030 Injection, methylprednisolone acetate, 40 mg	192	99	$9.00	$6.53
G0008 Administration of influenza virus vaccine	174	166	$38.00	$27.30
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	83	79	$33.00	$21.02
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	69	11	$5.00	$1.72
90662 Influenza vaccine split virus, preservative free	64	64	$110.00	$68.54
36415 Insertion of needle into vein for collection of blood sample	59	45	$16.00	$2.88
J1040 Injection, methylprednisolone acetate, 80 mg	44	35	$18.00	$10.54
80305 Testing for presence of drug, read by direct observation	34	22	$85.00	$12.53
0124A Fee covid-19 vac 13 res	30	30	$90.00	$36.16
82044 Urine microalbumin (protein) analysis	30	28	$12.00	$5.98
G0009 Administration of pneumococcal vaccine	29	29	$38.00	$27.53
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	29	29	$285.00	$160.20
90682 Influenza vaccine, quadrivalent derived from recombinant dna	27	27	$100.00	$68.54
87426 Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus	23	22	$129.78	$35.10
0064A Adm sarscov2 50mcg/0.25mlbst	18	18	$90.00	$36.43
92250 Photography of the retina	18	18	$128.00	$35.09
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	16	16	$516.69	$279.29
93000 Routine ekg using at least 12 leads including interpretation and report	14	13	$40.29	$13.41

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	883	277	$173.00	$122.67
J1885 Injection, ketorolac tromethamine, per 15 mg	640	52	$1.00	$0.49
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	480	123	$50.00	$13.46
99213 Established patient office or other outpatient visit, typically 15 minutes	436	213	$119.00	$85.81
83036 Hemoglobin A1C level	310	144	$23.00	$9.68
J1040 Injection, methylprednisolone acetate, 80 mg	280	110	$18.00	$10.62
G0008 Administration of influenza virus vaccine	196	196	$38.00	$15.83
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	158	158	$188.00	$126.96
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	119	119	$33.00	$20.52
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	107	107	$284.11	$161.60
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	106	16	$5.00	$1.99
G0009 Administration of pneumococcal vaccine	68	68	$38.00	$15.84
36415 Insertion of needle into vein for collection of blood sample	67	50	$13.85	$3.00
90682 Influenza vaccine, quadrivalent derived from recombinant dna	61	61	$100.00	$65.26
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	34	34	$203.35	$122.04
90670 Pneumococcal vaccine for injection into muscle	34	34	$354.12	$238.07
82044 Urine microalbumin (protein) analysis	33	29	$10.94	$6.23
81002 Urinalysis, manual test	24	22	$6.00	$3.48
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	17	17	$270.00	$161.92
86580 Skin test for tuberculosis	12	11	$15.00	$9.07
93000 Routine ekg using at least 12 leads including interpretation and report	12	12	$40.00	$13.96

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	848	288	$190.02	$103.58
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	746	158	$47.18	$13.57
J1885 Injection, ketorolac tromethamine, per 15 mg	669	58	$2.32	$0.57
99213 Established patient office or other outpatient visit, typically 15 minutes	636	283	$125.77	$71.27
36415 Insertion of needle into vein for collection of blood sample	512	309	$13.98	$2.97
J1040 Injection, methylprednisolone acetate, 80 mg	374	144	$16.18	$11.55
83036 Hemoglobin A1C level	306	147	$62.00	$9.64
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	143	143	$234.85	$111.09
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	142	22	$11.46	$2.00
G0008 Administration of influenza virus vaccine	139	136	$42.57	$15.86
G0444 Annual depression screening, 5 to 15 minutes	94	94	$30.00	$17.29
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	63	63	$25.38	$19.17
90674 Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free	54	54	$36.00	$29.23
81003 Automated urinalysis test	53	42	$19.00	$2.23
82044 Urine microalbumin (protein) analysis	52	52	$16.00	$6.23
17000 Destruction of skin growth	51	31	$91.10	$60.93
80305 Testing for presence of drug, read by direct observation	37	20	$60.00	$12.44
93000 Routine ekg using at least 12 leads including interpretation and report	25	24	$50.92	$16.06
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	22	21	$29.82	$19.41
G0009 Administration of pneumococcal vaccine	17	17	$40.76	$15.81
69209 Removal of impacted ear wax by washing	16	16	$46.50	$15.03
90670 Pneumococcal vaccine for injection into muscle	12	12	$282.50	$227.72

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	947	300	$191.00	$103.08
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	888	215	$47.00	$15.81
99213 Established patient office or other outpatient visit, typically 15 minutes	859	339	$126.00	$70.31
36415 Insertion of needle into vein for collection of blood sample	627	342	$14.00	$2.93
J1040 Injection, methylprednisolone acetate, 80 mg	505	200	$16.00	$12.13
83036 Hemoglobin A1C level	399	178	$62.00	$10.46
J1885 Injection, ketorolac tromethamine, per 15 mg	382	41	$2.50	$0.54
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	297	297	$176.52	$110.49
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	248	248	$28.00	$18.57
G0008 Administration of influenza virus vaccine	248	248	$43.00	$15.49
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	165	27	$11.13	$1.79
85610 Blood test, clotting time	92	13	$11.00	$4.28
17000 Destruction of skin growth	77	48	$86.00	$60.88
82044 Urine microalbumin (protein) analysis	64	61	$16.00	$5.94
81003 Automated urinalysis test	56	43	$19.00	$2.44
93000 Routine ekg using at least 12 leads including interpretation and report	21	20	$53.00	$15.98
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	19	19	$309.00	$156.14
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	18	18	$55.00	$42.63
G0009 Administration of pneumococcal vaccine	18	18	$25.00	$15.55
90670 Pneumococcal vaccine for injection into muscle	16	16	$256.25	$208.52
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	16	16	$206.88	$159.21
69209 Removal of impacted ear wax by washing	12	12	$46.50	$13.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,004	321	$126.00	$68.25
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	904	295	$191.00	$100.73
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	803	216	$47.00	$19.12
36415 Insertion of needle into vein for collection of blood sample	632	338	$14.00	$2.93
J1040 Injection, methylprednisolone acetate, 80 mg	480	204	$12.96	$12.08
83036 Hemoglobin A1C level	430	182	$62.00	$11.66
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	313	313	$165.00	$109.69
90674 Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free	285	284	$36.00	$23.49
G0008 Administration of influenza virus vaccine	284	283	$43.00	$19.10
85610 Blood test, clotting time	179	18	$11.00	$4.75
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	160	27	$4.00	$1.95
J1885 Injection, ketorolac tromethamine, per 15 mg	112	18	$2.50	$0.60
81003 Automated urinalysis test	62	44	$19.00	$2.71
J0696 Injection, ceftriaxone sodium, per 250 mg	56	11	$16.50	$0.60
17000 Destruction of skin growth	55	42	$86.00	$61.62
82044 Urine microalbumin (protein) analysis	35	35	$16.00	$6.11
69209 Removal of impacted ear wax by washing	34	29	$46.50	$12.66
87804 Detection test by immunoassay with direct visual observation for influenza virus	25	15	$27.50	$16.22
G0009 Administration of pneumococcal vaccine	22	22	$25.00	$19.10
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	18	18	$200.00	$157.11
90670 Pneumococcal vaccine for injection into muscle	16	16	$238.75	$198.72
93000 Routine ekg using at least 12 leads including interpretation and report	16	16	$53.00	$15.78
86580 Skin test for tuberculosis	12	11	$12.00	$7.32

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,113	345	$99.11	$68.19
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,013	317	$148.65	$100.46
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	818	219	$35.36	$23.67
36415 Insertion of needle into vein for collection of blood sample	645	342	$10.40	$2.93
J1040 Injection, methylprednisolone acetate, 80 mg	507	208	$12.00	$10.88
83036 Hemoglobin A1C level	431	179	$37.57	$13.03
G0008 Administration of influenza virus vaccine	272	270	$40.22	$23.63
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	241	241	$165.00	$108.87
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	241	29	$50.00	$42.47
85610 Blood test, clotting time	212	23	$11.00	$5.28
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	203	21	$50.00	$40.53
90674 Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free	193	192	$26.18	$23.40
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	148	23	$4.00	$2.92
J0696 Injection, ceftriaxone sodium, per 250 mg	124	18	$16.50	$0.66
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	113	29	$73.00	$65.65
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	84	84	$22.00	$18.43
17000 Destruction of skin growth	71	40	$86.00	$62.03
81003 Automated urinalysis test	63	54	$13.67	$3.02
82044 Urine microalbumin (protein) analysis	62	62	$16.00	$3.90
69209 Removal of impacted ear wax by washing	37	35	$46.50	$11.41
G0009 Administration of pneumococcal vaccine	31	31	$25.00	$23.63
90670 Pneumococcal vaccine for injection into muscle	25	25	$230.00	$185.61
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	20	20	$135.00	$123.96
93000 Routine ekg using at least 12 leads including interpretation and report	20	20	$53.00	$15.28
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	19	19	$200.00	$156.69
87804 Detection test by immunoassay with direct visual observation for influenza virus	18	18	$27.50	$16.11
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	14	14	$257.00	$154.55
90714 Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older	12	12	$37.00	$22.01
90471 Administration of 1 vaccine	11	11	$28.27	$23.76

Medical Specialties & State Licenses

CMS Verified: 2025-11-21

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License IN 01041214A

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

100094220 (IN)

Medicaid State Provider ID

64011372 (KY)

Commercial Insurance / Payer ID Aetna

646524 (IN)

Commercial Insurance / Payer ID Cigna

5448484002 (IN)

Commercial Insurance / Payer ID Humana

N41214 (IN)

Commercial Insurance / Payer ID Anthem

000000031460 (IN)

Commercial Insurance / Payer ID United Healthcare

0401309 (IN)

Commercial Insurance / Payer ID Unisys

64011372 (IN)

Commercial Insurance / Payer ID First Health

1349998 (IN)

Commercial Insurance / Payer ID United Healthcare Of Ohio

0401309 (IN)

Hospital & Practice Group Affiliations

Summit Medical Group Inc

112 Links Way, Aurora, IN 470011403

Phone: 8129263133

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

8 Associated Practitioners

Lauren Fox , APRN

Nurse Practitioner

NPI 1073285177

Advanced Practice Registered Nurse

Jeffrey Craven , LPCC

Counselor - Mental Health

NPI 1184883951

Licensed Professional Clinical Counselor

Jon Hautzenroeder , CNP

Nurse Practitioner

NPI 1205300886

Certified Nurse Practitioner

Carina Lewis , APRN

Nurse Practitioner

NPI 1457730665

Advanced Practice Registered Nurse

Dr. Jack Freidel , MD

Family Medicine

NPI 1487622551

Doctor of Medicine (M.D.)

Amy Hummel , CFNP

Nurse Practitioner

NPI 1821291758

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events

📍

Updated Practice Location November 21, 2025

Registered at 112 LINKS WAY, AURORA, IN 470011403 (Tel: 8124968783)

📍

Updated Business Mailing Address December 02, 2020

Registered at PO BOX 635283, CINCINNATI, OH 452635283 (Tel: 8593445555)

✅

NPI Profile Active January 04, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location January 04, 2016

Registered at 12930 NORTH STREET, DILLSBORO, IN 47018 (Tel: 8124323381)

📍

Updated Business Mailing Address January 04, 2016

Registered at PO BOX 4125, LAWRENCEBURG, IN 470254125 (Tel: 8124323381)

👤

Provider Name / Credentials Updated January 04, 2016

Recorded as RANDALL LEDUC, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 04, 2016

Internal Medicine (License #01041214A in IN)

🟢

Initial NPI Registration & Enumeration January 25, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1912053067

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: January 25, 2007

Last Update: November 21, 2025

Sole Proprietor: No

Update or Correct Profile

Mailing Address

Po Box 635283

Cincinnati, OH 452635283

Phone: 8124968783

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.