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Matthew Enzweiler

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NPI Number Detailed Information

Provider Information:

Name: Matthew Enzweiler
Gender: M
Provider License Number If Given: 223

NPI Information:

NPI: 1023017522
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 9/6/2018

Provider Business Mailing Address:

Address: PO BOX 635283
Cincinnati, OH 45263
Phone Number: 8592120175
Fax Number: 8597467464

Provider Business Practice Location Address:

Address: 525 ALEXANDRIA PIKE SUITE 230
Southgate, KY 41071
Phone Number: 8594414334
Fax Number: 8594413698

Provider Taxonomy:

Primary: 213ES0103X
Secondary (if any):
State: KY

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