Provider Demographics
NPI:1154563278
Name:JIVAN, VISHAL DHIROO (MD)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:DHIROO
Last Name:JIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-241-5489
Mailing Address - Fax:513-241-5490
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-241-5489
Practice Address - Fax:513-241-5490
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.099731207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201162960AMedicaid
KY7100132560Medicaid
OH0104068Medicaid