Divine, Jon G

Divine, Jon G is an individual health care provider with primary practice located at 222 Piedmont Ave Ml 0212, Cincinnati OH 45219-4231. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Divine, Jon G can be contacted via phone (513) 475-8690.

Contact Information

Primary practice address
222 Piedmont Ave Ml 0212 Cincinnati OH 45219-4231
Phone: (513) 475-8690
Fax: (513) 475-7593
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 35-070497 Ohio

Profile Details

NPI number 1659391761
LBN Legal business name Divine, Jon G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2006
Last updated Oct 17th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659391761 NPPES
Kentucky MEDICAID 64077175
Kentucky MEDICAID 2475503

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