Provider Demographics
NPI:1104091149
Name:TED M. LUM, M.D. INC
Entity type:Organization
Organization Name:TED M. LUM, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:513-221-6300
Mailing Address - Street 1:2825 BURNET AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2426
Mailing Address - Country:US
Mailing Address - Phone:513-221-6300
Mailing Address - Fax:513-221-6302
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2426
Practice Address - Country:US
Practice Address - Phone:513-221-6300
Practice Address - Fax:513-221-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561383Medicare PIN