Provider Demographics
NPI:1851746465
Name:KING, JUSTIN ROSSEL (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ROSSEL
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-6200
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:222 PIEDMONT AVE STE 5200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4222
Practice Address - Country:US
Practice Address - Phone:513-558-3700
Practice Address - Fax:513-475-8247
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301109885390200000X
IN11019205A390200000X
OH35.1509362086S0129X
IN01083614A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program