Provider Demographics
NPI:1063530277
Name:DILLMAN, JONATHAN RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RUSSELL
Last Name:DILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE 5021
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4225
Mailing Address - Fax:513-636-2511
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:RADIOLOGY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-2146
Practice Address - Fax:513-584-0431
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY487452085P0229X
OH35 1259302085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301083787OtherPHYSICIAN LICENSE