Provider Demographics
NPI:1902899214
Name:BISMAYER, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BISMAYER
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 1:5053 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2326
Mailing Address - Country:US
Mailing Address - Phone:513-751-2145
Mailing Address - Fax:513-751-2138
Practice Address - Street 1:8000 5 MILE RD
Practice Address - Street 2:#100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2163
Practice Address - Country:US
Practice Address - Phone:513-751-2273
Practice Address - Fax:513-751-1840
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036544207RH0003X
KY19916207RH0003X
IN01026470A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0282537Medicaid
IN200070360Medicaid
KY64764590Medicaid
IN900003552OtherMEDICARE RAILROAD
KY900003561OtherMEDICARE RAILROAD
OH900003531OtherMEDICARE RAILROAD
IN200070360Medicaid
OH0810749Medicare PIN
KY900003561OtherMEDICARE RAILROAD
INM400052360Medicare PIN