Provider Demographics
NPI:1528258266
Name:MEDACHE CLINIC, LLC
Entity type:Organization
Organization Name:MEDACHE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHIJUN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:513-826-0888
Mailing Address - Street 1:7921 SYMPHONY LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4304
Mailing Address - Country:US
Mailing Address - Phone:513-826-0888
Mailing Address - Fax:513-830-7060
Practice Address - Street 1:10495 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4468
Practice Address - Country:US
Practice Address - Phone:513-286-0888
Practice Address - Fax:513-830-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty